title: Everolimus-based immunosuppression in liver transplant recipients: a single-centre experience.
abstract: OBJECTIVE
  Everolimus, a mammalian target of rapamycin inhibitor, has been shown to reduce growth factor-mediated cell proliferation, but data regarding its effectiveness and impact on renal function and recurrence of hepatocellular carcinoma (HCC) in liver transplant (LT) recipients are limited.
  
  
  METHODS
  We evaluated LT recipients with a calcineurin inhibitor (CNI)-based immunosuppression regimen in whom everolimus treatment was initiated. The changes in laboratory data, including glomerular filtration rate (GFR), compared to the baseline (i.e. the day of everolimus conversion), were assessed.
  
  
  RESULTS
  Totally, 44 consecutive patients (32 men, age 55 ± 7 years) were commenced on everolimus [indications: renal dysfunction post-LT (16 patients, group 1); prevention of HCC recurrence (21 patients) or others (7 patients), group 2] at 6 months (range 1-206) post-LT. After 48 (range 12-76) months, all patients were alive without any rejection episodes. Compared to group 2 patients, group 1 patients had significantly greater improvement in renal function (DGFR: 12 ± 5 vs. -0.4 ± 0.2 ml/min, p = 0.02). GFR at baseline (OR 0.08, p = 0.002) and the combination of everolimus + MMF (OR 0.14, p = 0.024) were the factors independently associated with improvement in renal function. Finally, HCC recurrence was observed less frequently in the everolimus group of patients (n = 21) compared to the CNI-historical control group (n = 22) with HCC before LT [0/21 (0 %) vs. 4/22 (18.5 %), log rank p = 0.055), although the two groups of recipients had similar baseline characteristics and follow-up.
  
  
  CONCLUSIONS
  Everolimus is effective and is associated with low rates of HCC recurrence and improvement of renal function in LT recipients.
authors.affiliation: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School of Aristotle University, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece. cholongitas@yahoo.gr.
authors.forename: Εvangelos
authors.initials: Ε
authors.lastname: Cholongitas
authors.affiliation: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School of Aristotle University, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Goulis
authors.affiliation: 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Theocharidou
authors.affiliation: Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Antoniadis
authors.affiliation: Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fouzas
authors.affiliation: Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Giakoustidis
authors.affiliation: Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Imvrios
authors.affiliation: 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Giouleme
authors.affiliation: Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papanikolaou
authors.affiliation: 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School of Aristotle University, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Akriviadis
authors.affiliation: 1st Propedeutic Department of Internal Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Vasiliadis
keywords: Everolimus; Hepatocellular carcinoma; Liver transplantation; Mammalian target of rapamycin inhibitor; Renal function