Recommendations of everolimus use in liver transplant

Autores de IIS La Fe

• Ángel Rubín Suárez

  Autor

• Martín Prieto Castillo

  Autor

Participantes ajenos a IIS La Fe

• Bilbao Aguirre, Itxarone
• Fernandez-Castroagudin, Javier
• Pons Miñano JA
• Salcedo Plaza, Magdalena
• Varo Perez, Evaristo

Grupos

• Hepatología experimental y Trasplante hepático

• Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Abstract

Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice. (C) 2017 Elsevier Espana, S.L.U., AEEH y AEG. All rights reserved.

Keywords

• Liver transplantation; Immunosuppression; Everolimus; Sirolimus; Renal insufficiency; Nephrotoxicity; Hepatocellular carcinoma