Clinical recommendations for the use of everolimus in heart transplantation.
Proliferation signal inhibitors (PSIs), everolimus (EVL), and sirolimus are a group of immunosuppressor agents indicated for the prevention of acute rejection in adult heart transplant recipients. Proliferation signal inhibitors have a mechanism of action with both immunosuppressive and antiproliferative effects, representing an especially interesting treatment option for the prevention and management of some specific conditions in heart transplant population, such as graft vasculopathy or malignancies. Proliferation signal inhibitors have been observed to work synergistically with calcineurin inhibitors (CNIs). Data from clinical trials and from the growing clinical experience show that when administered concomitantly with CNIs, PSIs allow significant dose reductions of the latter without loss of efficacy, a fact that has been associated with stabilization or significant improvement in renal function in patients with CNI-induced nephrotoxicity. The purpose of this article was to review the current knowledge of the role of PSIs in heart transplantation to provide recommendations for the proper use of EVL in cardiac transplant recipients, including indications, treatment regimens, monitoring, and management of the adverse events.
Manito
Nicolás
N
Unitat d'Insuficiència Cardiaca i Trasplantament, Servei de Cardiologia, Hospital Universitari de Bellvitge, Barcelona, Spain. nml@bellvitgehospital.cat
Delgado
Juan F
JF
Crespo-Leiro
Maria G
MG
González-Vílchez
Francisco
F
Almenar
Luis
L
Arizón
José M
JM
Díaz
Beatriz
B
Fernández-Yáñez
Juan
J
Mirabet
Sònia
S
Palomo
Jesús
J
Rodríguez Lambert
José L
JL
Roig
Eulàlia
E
Segovia
Javier
J
D000068338:Everolimus; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus