13th Congress of the Asian Society of Transplantation: Hepatic, thoracic and pancreatic transplantation
Liver transplantation
Experience of Using Everolimus in the Early Stage of Living Donor Liver Transplantation

https://doi.org/10.1016/j.transproceed.2013.11.068Get rights and content

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.

Section snippets

Materials and Methods

From February 2012 to December 2012, 80 patients were studied prospectively who underwent living donor liver transplantation for various indications. Forty-three patients (53.7%) received everolimus along with CNI-based immunosuppressive therapy. We studied the effects of everolimus in liver transplant recipients with HCC and poor renal function as well as the graft outcome and toxic profile during early phase after living donor liver transplantation.

Inclusion criteria for the present

Results

The characteristics of the patients' data are given in Table 1. Forty-three patients were given everolimus-based immunosuppressive therapy in the present study. Ten females and 33 males comprised the cohort with a mean age of 57 years (range, 39–75 years). Thirty-nine (90.69%) patients had HCC as the primary cause for transplantation, whereas 9 (20.93%) patients had renal insufficiency prior to transplantation. The mean time between liver transplantation and everolimus treatment was 12 ± 8 days

Discussion

Although preliminary efforts suggest that m-TOR therapy may be associated with a substantial reduction in renal toxicity and acute cellular rejection, some serious concerns such as delayed wound healing, infections, incisional hernias, and higher incidence of arterial thrombosis have evolved [9]. However, these alarming findings were not observed in our series and the use of everolimus proved to be safe in the early phase with no arterial complications as well as incisional hernias after a

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