title: Clinical recommendations for the use of everolimus in heart transplantation.
abstract: 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.
authors.affiliation: Unitat d'Insuficiència Cardiaca i Trasplantament, Servei de Cardiologia, Hospital Universitari de Bellvitge, Barcelona, Spain. nml@bellvitgehospital.cat
authors.forename: Nicolás
authors.initials: N
authors.lastname: Manito
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: Francisco
authors.initials: F
authors.lastname: González-Vílchez
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.forename: José M
authors.initials: JM
authors.lastname: Arizón
authors.forename: Beatriz
authors.initials: B
authors.lastname: Díaz
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Yáñez
authors.forename: Sònia
authors.initials: S
authors.lastname: Mirabet
authors.forename: Jesús
authors.initials: J
authors.lastname: Palomo
authors.forename: José L
authors.initials: JL
authors.lastname: Rodríguez Lambert
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus