AIM: To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical practice. METHODS: From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients (7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation and post-conversion survival were analyzed. RESULTS: Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo (range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo (range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of patients. CONCLUSION: Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.
AIM: To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical practice. METHODS: From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients (7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation and post-conversion survival were analyzed. RESULTS: Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo (range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo (range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of patients. CONCLUSION:Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.
Authors: M Masetti; R Montalti; G Rompianesi; M Codeluppi; R Gerring; A Romano; B Begliomini; F Di Benedetto; G E Gerunda Journal: Am J Transplant Date: 2010-09-03 Impact factor: 8.086
Authors: W Schuler; R Sedrani; S Cottens; B Häberlin; M Schulz; H J Schuurman; G Zenke; H G Zerwes; M H Schreier Journal: Transplantation Date: 1997-07-15 Impact factor: 4.939
Authors: L Fischer; J Klempnauer; S Beckebaum; H J Metselaar; P Neuhaus; P Schemmer; U Settmacher; N Heyne; P-A Clavien; F Muehlbacher; I Morard; H Wolters; W Vogel; T Becker; M Sterneck; F Lehner; C Klein; G Kazemier; A Pascher; J Schmidt; F Rauchfuss; A Schnitzbauer; S Nadalin; M Hack; S Ladenburger; H J Schlitt Journal: Am J Transplant Date: 2012-04-11 Impact factor: 8.086
Authors: M Masetti; G Rompianesi; R Montalti; A Romano; M Spaggiari; R Ballarin; G P Guerrini; G E Gerunda Journal: Transplant Proc Date: 2008 Jul-Aug Impact factor: 1.066
Authors: C Alegre; C Jiménez; A Manrique; M Abradelo; J Calvo; C Loinaz; A García-Sesma; F Cambra; E Alvaro; M García; R Sanabria; I Justo; O Caso; E Moreno Journal: Transplant Proc Date: 2013-06 Impact factor: 1.066