title: Tolerability of everolimus-based immunosuppression in maintenance liver transplant recipients.
abstract: BACKGROUND
  The aim of this study was to evaluate the tolerability of the conversion from calcineurin inhibitor (CNI) to everolimus (ERL) in maintenance liver transplant (LT) recipients.
  
  
  METHODS
  From January 2005 to March 2008, ERL was introduced after LT as maintenance immunosuppressive therapy because of (i) de novo or recurrent cancer after LT, (ii) pre-existing liver carcinoma on the liver explant or (iii) CNI toxicity. CNI dosage was progressively reduced until discontinuation.
  
  
  RESULTS
  The study population included 94 patients, of mean age 57 ± 10. The mean delay between LT and ERL introduction was 5 ± 5 yr. After a mean follow-up of 12 ± 7 months, 70% of the patients did present at least one side effect. The mean trough level of ERL was 6 μg/L at the end of follow-up. Main side effects included hyperlipidemia (37%), dermatitis (19%), mucositis (15%), and proteinuria (18%). Biopsy-proven acute rejection occurred in 9% of patients. Global ERL discontinuation rate was 21% (16% because of side effects).
  
  
  CONCLUSIONS
  The results of our experience indicate that conversion to ERL is associated with adverse effects in 70% of patients leading to drug discontinuation in 16% (and amenable to dose reduction in the remainders). Longer follow-up periods are necessary to capture the impact of ERL fully on renal function and survival in cancer patients.
authors.affiliation: Liver Transplantation Unit, Edouard Herriot Hospital, Lyon, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Vallin
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morard
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Gagnieu
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
mesh_terms: D065095:Calcineurin Inhibitors; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use*; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D020123:Sirolimus; D016559:Tacrolimus