Jeng L-B, Thorat A, Hsieh Y-W, Yang H-R, Yeh C-C, Chen T-H, Hsu S-C, Hsu C-H
Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
Transplant Proc. 2014 Apr;46(3):744-8. doi: 10.1016/j.transproceed.2013.11.068.
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.
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.
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.
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.
我们研究的目的是回顾成人对成人活体肝移植受者早期使用依维莫司的经验。
2012年2月至2012年12月，80例受者接受了活体肝移植。其中43例在术后早期将依维莫司作为钙调神经磷酸酶抑制剂（CNIs）的辅助用药。39例患者患有肝细胞癌（HCC），9例患者肾功能较差。其中10例为女性，33例为男性。年龄在39至75岁之间。33例患者在1周内开始使用，9例在2周内开始使用，1例在术后第20天给药。依维莫司的初始剂量为每12小时0.25mg，增加至每12小时0.5mg，目标血药浓度为3 - 5ng/mL。术后第1、4和14天定期进行多普勒超声检查。
肝移植与依维莫司治疗之间的平均时间为12±8天。依维莫司的最大使用剂量为1mg/d，目标谷浓度在3至5ng/mL之间。在3个月时，达到了3ng/mL的目标谷浓度。9例肾衰竭患者中有6例肾功能显著恢复，而其中3例进一步恶化，1例需要血液透析。在9±6个月的随访期内，所有患者肝动脉通畅良好，无血栓形成。3例患者（7%）发生HCC复发，1例患者在术后第10个月因败血症死亡。5例患者出现血脂升高。口腔炎是最常见的副作用，15例患者出现。
早期使用依维莫司是安全可行的。此外，它可以安全地用于既往有肾衰竭的患者，同时减少CNIs的剂量。虽然HCC的复发率降低了，但正在进行进一步研究以评估依维莫司对预防HCC复发的长期影响。
