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Sirolimus mTOR Side Effects — ESENeph MCQ

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ModerateTransplantationSirolimus mTOR Side EffectsESENeph

A 55-year-old man with a kidney transplant on Sirolimus develops mouth ulcers, peripheral oedema, and hyperlipidaemia. His FBC shows pancytopenia. What class of immunosuppressant is Sirolimus and what are its characteristic side effects?

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Correct answer: B — mTOR inhibitor – characteristic side effects include oral ulceration, hyperlipidaemia, peripheral oedema, proteinuria, impaired wound healing, and dose-dependent cytopenias

Sirolimus (and Everolimus) are mTOR inhibitors that block the PI3K/Akt/mTOR pathway, inhibiting T-cell proliferation at a different point than CNIs. Characteristic side effects include: oral ulcers (30-60%), hyperlipidaemia (cholesterol and triglycerides), peripheral oedema (non-cardiac), proteinuria (podocyte dysfunction), impaired wound healing, and dose-dependent cytopenias. They are used as CNI-sparing agents (particularly for CNI nephrotoxicity or post-transplant malignancy due to their anti-proliferative properties). They should not be used in the immediate post-transplant period (impaired wound healing risk).

Reference: KDIGO 2009 – Transplant; BNF – Sirolimus