title: Everolimus immunosuppression in de novo heart transplant recipients: what does the evidence tell us now?
abstract: The efficacy of everolimus with reduced cyclosporine in de novo heart transplant patients has been demonstrated convincingly in randomized studies. Moreover, everolimus-based immunosuppression in de novo heart transplant recipients has been shown in two randomized trials to reduce the increase in maximal intimal thickness based on intravascular ultrasound, indicating attenuation of cardiac allograft vasculopathy (CAV). Randomized trials of everolimus in de novo heart transplantation have also consistently shown reduced cytomegalovirus infection versus antimetabolite therapy. In maintenance heart transplantation, conversion from calcineurin inhibitors to everolimus has demonstrated a sustained improvement in renal function. In de novo patients, a renal benefit may only be achieved if there is an adequate reduction in exposure to calcineurin inhibitor therapy. Delayed introduction of everolimus may be appropriate in patients at high risk of wound healing complications, e.g. diabetic patients or patients with ventricular assist device. The current evidence base suggests that the most convincing reasons for use of everolimus from the time of heart transplantation are to slow the progression of CAV and to lower the risk of cytomegalovirus infection. A regimen of everolimus with reduced-exposure calcineurin inhibitor and steroids in de novo heart transplant patients represents a welcome addition to the therapeutic armamentarium.
authors: Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. andreas.zuckermann@meduniwien.ac.at
authors: Andreas
authors: A
authors: Zuckermann
authors: Shoei-Shen
authors: SS
authors: Wang
authors: Eric
authors: E
authors: Epailly
authors: Markus J
authors: MJ
authors: Barten
authors: Vilborg
authors: V
authors: Sigurdardottir
authors: Javier
authors: J
authors: Segovia
authors: Shaida
authors: S
authors: Varnous
authors: Fabio M
authors: FM
authors: Turazza
authors: Luciano
authors: L
authors: Potena
authors: Hans B
authors: HB
authors: Lehmkuhl
mesh_terms: D000068338:Everolimus; D019317:Evidence-Based Medicine; D006084:Graft Rejection / Q000188:drug therapy* / Q000453:epidemiology; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus