title: The efficacy and safety of mammalian target of rapamycin inhibitors ab initio after liver transplantation without corticosteroids or induction therapy.
abstract: BACKGROUND
  Mammalian target of rapamycin inhibitors have been used along with corticosteroids and/or induction therapy immediately after liver transplantation. Our aim was to assess the safety and tolerability of everolimus ab initio after liver transplantation without corticosteroids or induction, as well as efficacy in terms of liver function, rejection and graft loss.
  
  
  METHODS
  A retrospective observational study of 50 adult patients (86% males, median age 54 years, range 25-68) who were liver transplanted between 2009 and 2013 and followed for 12 months. All recipients received everolimus plus low doses of calcineurin inhibitors (n=38) or mycophenolate (n=12) without corticosteroids and/or induction from the day of transplant.
  
  
  RESULTS
  The overall patient and graft survival was 80%. Liver function was stable during one year follow-up. No rejections or graft loss were observed. Only five patients (10%) required therapy for onset dyslipidemia.
  
  
  CONCLUSIONS
  Everolimus-based immunosuppression regimen without corticosteroids and/or induction immediately after liver transplantation seems to be safe and effective when administered with low doses of calcineurin-inhibitor or mycophenolate; although these findings require further investigation, these regimens could avoid adverse effects of standard immunosuppression regimens with higher doses.
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy. Electronic address: tomanzia@libero.it.
authors.forename: Tommaso Maria
authors.initials: TM
authors.lastname: Manzia
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Angelico
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Toti
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Belardi
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Annagrazia
authors.initials: A
authors.lastname: Cillis
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Quaranta
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.affiliation: Wake Forest School of Medicine, Winston Salem, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Katari
authors.affiliation: Wake Forest School of Medicine, Winston Salem, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Mogul
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sforza
authors.affiliation: Wake Forest School of Medicine, Winston Salem, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D012189:Retrospective Studies; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid
keywords: Acute rejection; Everolimus; Liver transplantation; mTORi