Bilbao Itxarone, Dopazo Cristina, Lazaro Jose, Castells Lluis, Caralt Mireia, Sapisochin Gonzalo, Charco Ramon
Itxarone Bilbao, Cristina Dopazo, Jose Lazaro, Mireia Caralt, Gonzalo Sapisochin, Ramon Charco, Hepatobiliopancreatic Surgery and Liver Transplant Unit of the Department of General Surgery, Hospital Vall Hebrón, Universidad Autónoma Barcelona, 08035 Barcelona, Spain.
World J Transplant. 2014 Jun 24;4(2):122-32. doi: 10.5500/wjt.v4.i2.122.
To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical practice.
From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients (7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation and post-conversion survival were analyzed.
Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo (range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo (range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of patients.
Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.
评估我们在肝移植后使用和管理依维莫司方案的经验，并重新定义该药物在当前临床实践中的潜在作用。
1988年10月至2012年12月，我们科室对955例患者进行了1023例肝移植手术。74例患者（7.74%）在移植后的某个时间接受了依维莫司免疫抑制治疗。分析了患者的人口统计学特征、依维莫司的使用指征、从移植到开始使用依维莫司的时间、给药剂量和血药浓度、疗效、副作用、停药情况以及转换治疗后的生存率。
转换为依维莫司治疗时的平均年龄为57.7±10岁。转换治疗的指征包括：难治性排斥反应31.1%、移植肝中广泛肝细胞癌19%、移植后肝细胞癌复发8.1%、新发肿瘤17.6%、肾功能不全8.1%、严重神经毒性10.8%以及其他5.4%。从移植到开始使用依维莫司的中位时间为6个月（范围：0.10 - 192个月）。转换治疗后的平均随访时间为22±19个月（范围：0.50 - 74个月）。60.8%的患者中药物所针对的事件得到解决，在难治性排斥反应、肾功能不全和神经毒性病例中效果最佳。癌症患者的结果与接受其他免疫抑制剂治疗的历史队列相似。主要副作用为血脂异常和感染。转换治疗后14.9%的病例发生急性排斥反应。28.4%的患者停用了该药物。
低剂量依维莫司联合他克莫司是一种安全的免疫抑制剂，在肝移植后有多种早期和晚期使用指征。
