Use of Everolimus After Multivisceral Transplantation: A Report of Two Cases

Area of Science:

• Transplantation immunology
• Oncology
• Pharmacology

Background:

• Mechanistic target of rapamycin (mTOR) inhibitors are utilized in solid organ transplantation to mitigate calcineurin inhibitor-associated nephrotoxicity and malignancy.
• Neuroendocrine tumors (NETs) pose a recurrence risk post-transplantation, necessitating strategies for both oncologic control and renal preservation.

Observation:

• Two cases of multivisceral transplantation for NETs are presented, where everolimus was administered to prevent tumor recurrence and preserve renal function.
• The first patient experienced NET recurrence prior to everolimus initiation, followed by ventral hernia and elevated aminotransferase levels post-initiation.
• The second patient developed cytomegalovirus infection with supratherapeutic everolimus trough levels and acute cellular rejection.

Findings:

• Everolimus was reinitiated in both cases, alongside reduced tacrolimus dosages, leading to resolution of complications.
• Everolimus demonstrated efficacy in stabilizing renal function in both patients.
• The study highlights the theoretical potential of everolimus in preventing NET recurrence.

Implications:

• Everolimus may offer a dual benefit in multivisceral transplantation for NETs, addressing both oncologic and nephroprotective goals.
• Careful monitoring of everolimus levels and potential side effects is crucial in this patient population.
• Further research is warranted to confirm the efficacy of everolimus in preventing NET recurrence post-transplantation.