Angioedema in Renal Transplant Recipients on Sirolimus

Background: Most drug-associated angioedemas are induced by angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, or nonsteroidal anti-inflammatory drugs. Recently, the responsibility of immunosuppressive agents given to transplant recipients in the development of angioedema has been discussed.

Objective: To describe, in detail, angioedema episodes in renal transplant recipients (RTRs) on sirolimus.

Methods: A cross-sectional study in a university hospital. Eighty consecutive RTRs on sirolimus were studied.

Results: Angioedema without urticaria occurred a mean of 5 times in 12/80 (15%) RTRs taking sirolimus. It was predominantly located on the face (83%), with mucous membrane involvement in 7 (58%) patients, and was life threatening in 1. Another putative cofactor for angioedema without urticaria was identified in 9 (75%) patients: drugs (n=8), food allergy or physical activity (n=3). Tacrolimus intake was significantly associated with sirolimus-associated angioedema.

Conclusion: Our results suggested a causal relationship between sirolimus and angioedema in RTRs.