title: Multiple indications for everolimus after liver transplantation in current clinical practice.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.
authors.affiliation: 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.
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.affiliation: 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.
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.affiliation: 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.
authors.forename: Jose
authors.initials: J
authors.lastname: Lazaro
authors.affiliation: 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.
authors.forename: Lluis
authors.initials: L
authors.lastname: Castells
authors.affiliation: 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.
authors.forename: Mireia
authors.initials: M
authors.lastname: Caralt
authors.affiliation: 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.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.affiliation: 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.
authors.forename: Ramon
authors.initials: R
authors.lastname: Charco
keywords: Everolimus; Indications; Liver transplantation; Off-protocol; Outcome