Comparison of everolimus with calcineurin inhibitors in maintenance immunosuppression

The conventional triple immunosuppressive regimen administered following heart transplantation typically comprises a calcineurin inhibitor, an antiproliferative agent, and corticosteroids. Everolimus has emerged as a viable alternative to calcineurin inhibitors. This study aims to evaluate the immunosuppressive efficacy and adverse effect profile of everolimus when introduced after the first post-transplant year, in comparison to continued calcineurin inhibitor therapy.

A retrospective analysis was conducted on 90 heart transplant recipients under regular follow up. Patients were categorized into two groups: those who maintained calcineurin inhibitor therapy beyond the first year post-transplant (n = 45), and those who transitioned to everolimus after the first year (n = 45). The groups were compared in terms of rejection incidence and side effects.

Following the treatment modification, the everolimus group showed a significant improvement in serum urea and creatinine levels (p < 0.05). Rejection rates after the first year were found to be similar between the two groups.

Everolimus provides effective immunosuppression with a lower rate of side effects.It demonstrates a favorable impact on renal function without increasing the risk of rejection.The first year may be recommended as the optimal timing, considering both safe wound healing and the risk of rejection.