Schweiger Martin, Stiegler Philipp, Puntschart Andreas, Sereinigg Michael, Prenner Guenther, Wasler Andre, Tscheliessnigg Karlheinz
Department for Surgery, Division for Transplantation Surgery, Medical University Graz, Graz, Austria.
Exp Clin Transplant. 2012 Jun;10(3):273-7. doi: 10.6002/ect.2011.0156.
We examined the experiences of heart transplant recipients receiving everolimus as maintenance therapy in different combinations over a long time.
Between 2004 and 2009, forty patients (29 men, 11 women; mean age, 51.6 y) were switched from a routine immunosuppressive regimen to everolimus. Indications were other (2), renal insufficiency (17), cardiac allograft vasculopathy (14), and ongoing cellular rejection (7). Combinations were either along with cyclosporine (24), mycophenolate mofetil (14), or others (2). Indications for the introduction of everolimus including safety, efficacy, different combinations of everolimus, biopsy-proven acute rejections, renal function, and infections were evaluated retrospectively.
Five patients died, 4 of them were still on everolimus at the time of death; they died from intracerebral hemorrhage (1), embolism (1), cardiac arrest (2), and unknown (1). Everolimus was discontinued in 6 patients owing to severe adverse effects: Edema (2), gastrointestinal adverse effects (3), and dermal adverse effects (1). Mean everolimus trough levels were 5.8 μmol/L at 6 months and 4.9 at 60 months. Mean cyclosporine levels were 67.62 μmol/L at 6 months and 47.3 μmol/L at 60 months. Mean serum creatinine levels were stable (147.9 μmol/L after 60 months). Four life-threatening infections (all pneumonia) occurred but resulted in complete recovery.
Everolimus is safe with different immunosuppressive combinations after receiving a heart transplant.
我们研究了心脏移植受者长期接受不同组合的依维莫司维持治疗的经历。
2004年至2009年期间，40例患者（29例男性，11例女性；平均年龄51.6岁）从常规免疫抑制方案转换为依维莫司治疗。转换原因包括其他情况（2例）、肾功能不全（17例）、心脏移植血管病变（14例）和持续性细胞排斥反应（7例）。联合用药方案包括与环孢素联合（24例）、与霉酚酸酯联合（14例）或其他方案（2例）。回顾性评估了引入依维莫司的指征，包括安全性、疗效、依维莫司的不同组合、活检证实的急性排斥反应、肾功能和感染情况。
5例患者死亡，其中4例在死亡时仍在使用依维莫司；死亡原因分别为脑出血（1例）、栓塞（1例）、心脏骤停（2例）和不明原因（1例）。6例患者因严重不良反应停用依维莫司：水肿（2例）、胃肠道不良反应（3例）和皮肤不良反应（1例）。依维莫司的平均谷浓度在6个月时为5.8 μmol/L，在60个月时为4.9 μmol/L。环孢素的平均浓度在6个月时为67.62 μmol/L，在60个月时为47.3 μmol/L。血清肌酐平均水平保持稳定（60个月后为147.9 μmol/L）。发生了4例危及生命的感染（均为肺炎），但均完全康复。
心脏移植后，依维莫司与不同的免疫抑制组合联合使用是安全的。
