Immunosuppressive treatment with everolimus in patients after liver transplant: 4 years of single-center experience

摘要

Introduction: Everolimus after liver transplant (LT) has been used to minimize the?use of calcineurin inhibitors (CNIs), optimize renal function, and prevent recurrence of hepatocellular carcinoma (HCC). Objectives: We aimed to analyze a?single-center experience with switching from CNIs to everolimus in immunossupressive treatment of LT recipients. Patients and methods: A?total of 108 LT recipients (men, 65.7%; mean [SD] age, 53.2 [11.1] years) were prospectively enrolled into the?study. In all patients, everolimus and CNIs were introduced (target trough levels of 3 to 6?ng/ml and 3 to 5?ng/ml, respectively). After 3 months, CNIs were discontinued in patients who tolerated everolimus well, while everolimus dosage was increased (blood trough levels, 6–12?ng/ml). Results: Everolimus monotherapy was introduced in 32 patients (29.6%), while a?combination therapy with everolimus and CNIs was continued in 76 patients (70.4%). However, during a?mean follow-up of 27 months (range, 4–50 months), everolimus was withdrawn in 25 patients (33%) due to side effects. In the?everolimus-monotherapy group, all patients continued the?therapy ( P 0.005), but dyslipidemia was more frequent than in patients receiving everolimus and CNIs (40.6% vs 14.5%; P 0.03). Creatinine levels improved significantly in both groups: combination therapy, from 1.58?mg/dl to 1.24?mg/dl after 3 months, and everolimus monotherapy, from 1.19?mg/dl to more than 1?mg/dl. Renal function in the?everolimus group was better than in the?combination-therapy group ( P 0.04). Recurrence of HCC was observed in both groups: combination therapy (9/46 [19.6%]) and everolimus monotherapy (1/17 [5.9%]; P 0.01). Conclusions: This study showed that switching from CNIs to everolimus after LT allowed a?safe weaning of CNIs and an?improvement in creatinine levels. In patients on everolimus monotherapy, we observed dyslipidemia as a?dose-dependent side effect of the?drug as well as a?lower risk of HCC recurrence.