Clinical Pearl

Sirolimus (Rapamycin) is never given as an initial agent of immunosuppression after liver transplantation.  Why?  Two reasons, each a part of its side effect profile: impaired wound healing and hepatic artery thrombosis.  At this center the following three agents are used as primary immunosuppression: tacrolimus (Prograf), mycophenolate mofetil (Cellcept) and steroids.

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