Alegre C, Jiménez C, Manrique A, Abradelo M, Calvo J, Loinaz C, García-Sesma A, Cambra F, Alvaro E, García M, Sanabria R, Justo I, Caso O, Moreno E
12 de Octubre University Hospital, Madrid, Spain.
Transplant Proc. 2013 Jun;45(5):1971-4. doi: 10.1016/j.transproceed.2013.01.075.
Everolimus is a potent immunosuppressant with several advantages over calcineurin inhibitors, such as good tolerance, preventive effects on cardiovascular morbidity, and mortality and cancer prevention as it inhibits cell proliferation.
Between April 1986 and December 2010, we performed 1500 liver transplants (OLT) in 1341 recipients, including 57 patients who were prescribed everolimus 24 (42.1%) as monotherapy and 33 (57.9%) as treatments combined with other immunosuppressants. We performed a retrospective analysis of our experience with conversion to everolimus in OLT recipients.
The 43 men and 14 women had a mean overall age at transplantation of 59.1 ± 10 years. The most frequent indication for OLT was hepatocellular carcinoma (HCC; 53.8%). Everolimus was introduced to prevent HCC recurrence (53%), development of de novo tumors (33%), address renal dysfunction (7%), or overcome side effects of other immunosuppressants (7%). We observed a significant improvement in renal function using the estimated glomerular filtration rate (Crockcroft-Gault formula) from 68.5 mL/min before to 74.5 mL/min after switching to everolimus. The 72% of recipients who developed ≥1 adverse event, most frequently showed hyperlipidemia (34.4%).
Both monotherapy and combined everolimus regimens were well-tolerated immunosuppressive regimens in liver transplant recipients with recurrent or de novo malignancies. Everolimus improved renal function. The most common side effects were hyperlipidemia, edema, and mouth ulcerations, which were well controlled with anti-lipidemic agents or decreased everolimus dosages.
依维莫司是一种强效免疫抑制剂，与钙调神经磷酸酶抑制剂相比具有多个优势，例如耐受性良好、对心血管疾病发病率和死亡率有预防作用以及因其抑制细胞增殖而具有防癌作用。
在1986年4月至2010年12月期间，我们对1341名受者进行了1500例肝移植手术（OLT），其中57例患者（42.1%）接受依维莫司单药治疗，33例患者（57.9%）接受依维莫司与其他免疫抑制剂联合治疗。我们对肝移植受者转换为依维莫司治疗的经验进行了回顾性分析。
43名男性和14名女性移植时的平均年龄为59.1±10岁。OLT最常见的适应证是肝细胞癌（HCC；53.8%）。引入依维莫司是为了预防HCC复发（53%）、新发肿瘤的发生（33%）、解决肾功能障碍（7%）或克服其他免疫抑制剂的副作用（7%）。使用估算肾小球滤过率（Cockcroft-Gault公式），我们观察到肾功能有显著改善，从转换为依维莫司前的68.5 mL/分钟提高到转换后的74.5 mL/分钟。72%发生≥1次不良事件的受者最常出现高脂血症（34.4%）。
在复发性或新发恶性肿瘤的肝移植受者中，依维莫司单药治疗方案和联合治疗方案都是耐受性良好的免疫抑制方案。依维莫司改善了肾功能。最常见的副作用是高脂血症、水肿和口腔溃疡，使用降脂药物或降低依维莫司剂量可得到良好控制。
