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Hepatology International

, Volume 8, Issue 1, pp 137–145 | Cite as

Everolimus-based immunosuppression in liver transplant recipients: a single-centre experience

  • Εvangelos Cholongitas
  • Ioannis Goulis
  • Eleni Theocharidou
  • Nikolaos Antoniadis
  • Ioannis Fouzas
  • Dimitrios Giakoustidis
  • George Imvrios
  • Olga Giouleme
  • Vasilios Papanikolaou
  • Evangelos Akriviadis
  • Themistoklis Vasiliadis
Original Article

Abstract

Purpose

Everolimus, a mammalian target of rapamycin inhibitor, has been shown to reduce growth factor-mediated cell proliferation, but data regarding its effectiveness and impact on renal function and recurrence of hepatocellular carcinoma (HCC) in liver transplant (LT) recipients are limited.

Methods

We evaluated LT recipients with a calcineurin inhibitor (CNI)-based immunosuppression regimen in whom everolimus treatment was initiated. The changes in laboratory data, including glomerular filtration rate (GFR), compared to the baseline (i.e. the day of everolimus conversion), were assessed.

Results

Totally, 44 consecutive patients (32 men, age 55 ± 7 years) were commenced on everolimus [indications: renal dysfunction post-LT (16 patients, group 1); prevention of HCC recurrence (21 patients) or others (7 patients), group 2] at 6 months (range 1–206) post-LT. After 48 (range 12–76) months, all patients were alive without any rejection episodes. Compared to group 2 patients, group 1 patients had significantly greater improvement in renal function (DGFR: 12 ± 5 vs. −0.4 ± 0.2 ml/min, p = 0.02). GFR at baseline (OR 0.08, p = 0.002) and the combination of everolimus + MMF (OR 0.14, p = 0.024) were the factors independently associated with improvement in renal function. Finally, HCC recurrence was observed less frequently in the everolimus group of patients (n = 21) compared to the CNI-historical control group (n = 22) with HCC before LT [0/21 (0 %) vs. 4/22 (18.5 %), log rank p = 0.055), although the two groups of recipients had similar baseline characteristics and follow-up.

Conclusions

Everolimus is effective and is associated with low rates of HCC recurrence and improvement of renal function in LT recipients.

Keywords

Everolimus Liver transplantation Mammalian target of rapamycin inhibitor Renal function Hepatocellular carcinoma 

Abbreviations

HCC

Hepatocellular carcinoma

LT

Liver transplantation

GFR

Glomerular filtration rate

CNI

Calcineurin inhibitors

mTOR

Mammalian target of rapamycin

MMF

Mycophenolate mofetil

Notes

Compliance with ethical requirements and Conflict of interest

Εvangelos Cholongitas, Eleni Theocharidou, Ioannis Goulis, Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Olga Giouleme, Vasilios Papanikolaou, Evangelos Akriviadis, and Themistoklis Vasiliadis declare that all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5]. Informed consent was obtained from all patients for being included in the study. Evangelos Cholongitas, John Goulis, Evangelos Akriviadis, and Themistoklis Vasiliadis have served as lecturers for Gilead, Novartis and Bristol-Meier Squibb. Eleni Theocharidou, Ioannis Goulis, Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Olga Giouleme, and Vasilios Papanikolaou have no conflicts of interest.

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Copyright information

© Asian Pacific Association for the Study of the Liver 2013

Authors and Affiliations

  • Εvangelos Cholongitas
    • 1
  • Ioannis Goulis
    • 1
  • Eleni Theocharidou
    • 2
  • Nikolaos Antoniadis
    • 3
  • Ioannis Fouzas
    • 3
  • Dimitrios Giakoustidis
    • 3
  • George Imvrios
    • 3
  • Olga Giouleme
    • 2
  • Vasilios Papanikolaou
    • 3
  • Evangelos Akriviadis
    • 1
  • Themistoklis Vasiliadis
    • 4
  1. 1.4th Department of Internal Medicine, Hippokration General Hospital of ThessalonikiMedical School of Aristotle UniversityThessalonikiGreece
  2. 2.2nd Propedeutic Department of Internal Medicine, Hippokration HospitalMedical School of Aristotle UniversityThessalonikiGreece
  3. 3.Department of Transplant SurgeryAristotle University of ThessalonikiThessalonikiGreece
  4. 4.1st Propedeutic Department of Internal Medicine, AHEPA General Hospital Aristotle University of ThessalonikiThessalonikiGreece

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