Experience of using everolimus in the early stage of living donor liver transplantation

L-B Jeng; A Thorat; Y-W Hsieh; H-R Yang; C-C Yeh; T-H Chen; S-C Hsu; C-H Hsu

doi:10.1016/j.transproceed.2013.11.068

Experience of using everolimus in the early stage of living donor liver transplantation

Transplant Proc. 2014 Apr;46(3):744-8. doi: 10.1016/j.transproceed.2013.11.068.

Authors

L-B Jeng¹, A Thorat², Y-W Hsieh³, H-R Yang⁴, C-C Yeh⁴, T-H Chen⁵, S-C Hsu⁵, C-H Hsu⁵

Affiliations

¹ Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan. Electronic address: otc@mail.cmuh.org.tw.
² Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
³ Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.
⁴ Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
⁵ Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.

PMID: 24767339
DOI: 10.1016/j.transproceed.2013.11.068

Abstract

Objectives: The aim of our study was to review the experience of early use of everolimus for recipients after adult-to-adult living donor liver transplantation.

Methods: From February 2012 to December 2012, 80 recipients underwent living donor liver transplantation. Forty-three of them used everolimus as an adjunct to the calcineurin inhibitors (CNIs) in the early postoperative period. Thirty-nine patients had hepatocellular carcinoma (HCC) and poor renal function was noted in 9 patients. Ten of them were females and 33 were males. The age varied from 39 to 75 years old. The starting date of use was within 1 week in 33 patients, 2 weeks in 9 patients, and 1 patient was administered on postoperative day 20. The initial doses of everolimus were 0.25 mg every 12 hours and increased to 0.5 mg every 12 hours to target the level at 3-5 ng/mL. Doppler ultrasound was performed regularly postoperative days 1, 4, and 14.

Results: The mean time between liver transplantation and everolimus treatment was 12 ± 8 days. The maximum dose of everolimus used was 1 mg/d with a target trough level between 3 and 5 ng/mL. At 3 months, a target trough level of 3 ng/mL was achieved. Six of 9 renal failure patients showed significant recovery of renal function, whereas 3 of them showed further deterioration and 1 required hemodialysis. During the follow-up period of 9 ± 6 months, all showed good patency of hepatic artery without thrombosis. Three patients (7%) developed HCC recurrence, whereas 1 patient died at the 10th month postoperative due to sepsis. Elevation of lipid profile was noted in 5 patients. Stomatitis was the most frequent side effect and occurred in 15 patients.

Conclusions: The early use of everolimus was safe and feasible. Also, it can be safely used in patients with prior renal failure while reducing the doses of CNIs. Although the recurrence rate of HCC was reduced, further study is ongoing to evaluate the long-term impact of everolimus on prevention of HCC recurrence.

MeSH terms

Everolimus
Female
Humans
Immunosuppressive Agents / administration & dosage*
Immunosuppressive Agents / adverse effects
Liver Transplantation*
Living Donors*
Male
Middle Aged
Sirolimus / administration & dosage
Sirolimus / adverse effects
Sirolimus / analogs & derivatives*

Substances

Immunosuppressive Agents
Everolimus
Sirolimus