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Published on: February 7, 2022
Clinical recommendations for the use of everolimus in heart transplantation
Nicolás Manito1, Juan F Delgado, Maria G Crespo-Leiro
1Unitat d'Insuficiència Cardiaca i Trasplantament, Servei de Cardiologia, Hospital Universitari de Bellvitge, Barcelona, Spain. nml@bellvitgehospital.cat
Abstract:
Proliferation signal inhibitors (PSIs), everolimus (EVL), and sirolimus are a group of immunosuppressor agents indicated for the prevention of acute rejection in adult heart transplant recipients. Proliferation signal inhibitors have a mechanism of action with both immunosuppressive and antiproliferative effects, representing an especially interesting treatment option for the prevention and management of some specific conditions in heart transplant population, such as graft vasculopathy or malignancies. Proliferation signal inhibitors have been observed to work synergistically with calcineurin inhibitors (CNIs). Data from clinical trials and from the growing clinical experience show that when administered concomitantly with CNIs, PSIs allow significant dose reductions of the latter without loss of efficacy, a fact that has been associated with stabilization or significant improvement in renal function in patients with CNI-induced nephrotoxicity. The purpose of this article was to review the current knowledge of the role of PSIs in heart transplantation to provide recommendations for the proper use of EVL in cardiac transplant recipients, including indications, treatment regimens, monitoring, and management of the adverse events.
Insights
Proliferation signal inhibitors (PSIs) like everolimus help prevent heart transplant rejection and manage complications. They allow reduced calcineurin inhibitor doses, improving kidney function in transplant patients.
Area of Science:
- Immunology
- Pharmacology
- Transplantation Medicine
Background:
- Proliferation signal inhibitors (PSIs), including everolimus (EVL) and sirolimus, are crucial immunosuppressants for adult heart transplant recipients.
- PSIs possess both immunosuppressive and antiproliferative properties, making them valuable for managing graft vasculopathy and malignancies post-transplant.
Purpose of the Study:
- To review the current role of PSIs in heart transplantation.
- To provide evidence-based recommendations for the use of everolimus (EVL) in cardiac transplant recipients.
Main Methods:
- Literature review of clinical trials and clinical experience.
- Analysis of PSI efficacy, safety, and synergistic effects with calcineurin inhibitors (CNIs).
Main Results:
- PSIs demonstrate synergistic effects with CNIs, enabling significant CNI dose reduction without compromising efficacy.
- Concomitant use of PSIs and CNIs is associated with stabilization or improvement in renal function, particularly in cases of CNI-induced nephrotoxicity.
Conclusions:
- Everolimus (EVL) offers a valuable therapeutic option in heart transplantation for preventing rejection and managing specific conditions.
- Recommendations cover indications, treatment regimens, monitoring, and adverse event management for EVL in cardiac transplant recipients.
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