#1

Organ transplant recipients use a combination of immunosuppressive drugs to prevent their immune system from rejecting the transplanted organ. Common drugs include Cyclosporine, Tacrolimus, Mycophenolate mofetil (CellCept), Azathioprine, Sirolimus/Rapamycin, Everolimus. Prednisone, Methylprednisolone, etc.

Do users of mTOR inhibitors (sirolimus and everolimus) live longer (or have a lower all-cause mortality over 5y) than non users? Do we have data on this?

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#2

They have higher rates of cardiovascular disease (why you should test apoB on rapa) compared to non-mTORi organ transplant patients. I don’t think they do.

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#3

I think generally rapamycin is much less used in organ transplant patients now because there are much better drugs for immune suppression (cyclosporin, etc.).

Most organ transplant patients are very sick people who have been sick for a very long time (think diabetes, etc. for many years to the point of destroying an organ) so they are also typically on many other drugs besides the immune suppression drugs.

So - given this, organ transplant patients typically live less long than non-organ transplant people, and my understanding is that the data is far too messy given the health state of the typical organ transplant patient, and the many drugs that they are likely taking both for disease conditions they have, as well as the new medications they take post transplant to maintain the new organ. So, lots of confounding factors that make it hard to evaluate with any confidence.

The two organs that are needed most frequently are kidneys and livers. About 83 percent of the people on the national transplant waiting list are waiting for kidney transplants and about 12 percent are waiting for liver transplants according to the United States Department of Health and Human Services. Living donors are able to donate either of these organs if they are a match to recipients.

About 2,600 people or about three percent of the transplant list are waiting for hearts. Other organs including lungs, pancreas, and intestines make up the rest of the waiting list. Although people of all ages are on the list, most of those awaiting intestine transplants are infants and children.

and why do people need new kidneys:

Why might I need a kidney transplant?

You may need a kidney transplant if you have end-stage renal disease (ESRD). This is a permanent condition of kidney failure. It often needs dialysis. This is a process used to remove wastes and other substances from the blood.

Some conditions of the kidneys that may result in ESRD include:

  • Repeated urinary infections
  • Kidney failure caused by diabetes or high blood pressure
  • Polycystic kidney disease or other inherited disorders
  • Glomerulonephritis, which is inflammation of the kidneys’ filtering units
  • Hemolytic uremic syndrome, a rare disorder that causes kidney failure
  • Lupus and other diseases of the immune system
  • Obstructions

Other conditions, such as congenital defects of the kidneys, may result in the need for a kidney transplant.

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#4

Haven’t seen any data on this and there would be a lot of confounding factors. There are some forum members in this situation.
Sirolimus is used rather rarely. It’s not listed among common meds for kidney transplant, and in the ER, I’ve only seen one patient on Sirolimus in the past 10 years.

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#5

As others have said, there are so many confounding variables that it wouldn’t produce a result anyone could trust, even slightly. Having said that, if someone did attempt an analysis and produce a paper, I wouldn’t be able to help but read it.

#6

Confounding variables are not a problem per se. Statisticians can handle that, and a well-done emulated trial can reach similar conclusions as an RCT (see: Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses: Results of 32 Clinical Trials 2023). But you need “big data”. Unfortunately, only 3k kidney transplants are performed per year in the UK! (there are more in the US, but without a universal healthcare system, it’s usually harder to conduct long-term association studies; that’s why most papers look at the UK, Sweden, or France). So yes, we’ll never be able to get the answer to my initial question with such a small pool of (very diverse) patients.

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