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Everolimus in liver transplantation
James F Trotter1, Luis Lizardo-Sanchez
1Baylor University Medical Center, 3410 Worth Street, #860 Dallas, Texas, USA.
Current Opinion in Organ Transplantation
|September 26, 2014
Summary
Everolimus offers effective immunosuppression in liver transplants without kidney damage. This FDA-approved drug, a mammalian target of rapamycin inhibitor, shows promise for managing side effects and potentially treating cancer in transplant recipients.
Area of Science:
- Immunology
- Transplantation Medicine
- Pharmacology
Background:
- Liver transplantation is a life-saving procedure requiring lifelong immunosuppression.
- Standard immunosuppressants like tacrolimus carry risks of significant renal toxicity.
- Novel immunosuppressive agents are needed to improve long-term outcomes and patient quality of life.
Purpose of the Study:
- To review the mechanism of action, side effects, and clinical role of everolimus (EVR) in liver transplantation.
- To analyze recent de-novo and conversion trial data for EVR in liver transplant recipients.
- To compare EVR with other immunosuppressive agents, particularly tacrolimus and sirolimus.
Main Methods:
- Systematic review of recent de-novo and conversion trials involving everolimus in liver transplantation.
- Analysis of clinical outcomes including death, graft loss, rejection, and renal function.
- Evaluation of side effect profiles and comparison with other mammalian target of rapamycin (mTOR) inhibitors.
Main Results:
- Everolimus (EVR), an FDA-approved mammalian target of rapamycin (mTOR) inhibitor, demonstrates comparable efficacy to standard immunosuppression with significantly reduced renal toxicity.
- De-novo EVR use with reduced tacrolimus showed similar survival and graft outcomes but improved renal function compared to tacrolimus monotherapy.
- Common side effects like stomatitis, hyperlipidemia, and cytopenias are manageable. EVR lacks the adverse effects of sirolimus on wound healing and hepatic artery thrombosis and may possess antineoplastic properties.
Conclusions:
- Everolimus is the sole FDA-approved mammalian target of rapamycin (mTOR) inhibitor for liver transplantation, offering non-inferior immunosuppression with the crucial advantage of preserving renal function.
- Its manageable side effect profile and potential antineoplastic benefits make it a valuable option for liver transplant recipients.
- Increased clinical adoption is anticipated as familiarity with EVR grows among healthcare providers.
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