Use of Everolimus After Multivisceral Transplantation: A Report of Two Cases.
Inhibitors of mechanistic target of rapamycin are used in solid organ transplant procedures to avoid calcineurin inhibitor complications, including nephrotoxicity and malignancy. We present 2 cases of multivisceral transplantation for neuroendocrine tumor (NET) for which everolimus was implemented for its potential to prevent NET recurrence as well as preserve renal function. The first case was complicated by NET recurrence in the liver before initiation of everolimus. After initiation of everolimus, the patient developed a ventral hernia and elevated aminotransferase levels with nonspecific biopsy findings. The second case was complicated by cytomegalovirus infection with elevated everolimus trough levels as well as acute cellular rejection. Everolimus was reinitiated in both cases in addition to decreasing the dosage of tacrolimus, and there were no further complications. Everolimus was beneficial in stabilizing renal function in both patients and has the theoretical potential to prevent recurrence of NET.
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.
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B
Rao
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan. Electronic address: msegovi3@hfhs.org.
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MC
Segovia
Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan.
M
M
Kazimi
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
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R
Parekh
Department of Pathology, Henry Ford Hospital, Detroit, Michigan.
M
M
Raoufi
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
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SM
Jafri
D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016559:Tacrolimus / Q000008:administration & dosage
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D016559:Tacrolimus