Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now?
Journal
Transplantation Reviews
Journal Volume
27
Journal Issue
3
Pages
76-84
Date Issued
2013
Author(s)
Zuckermann A.
Epailly E.
Barten M.J.
Sigurdardottir V.
Segovia J.
Varnous S.
Turazza F.M.
Potena L.
Lehmkuhl H.B.
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. ? 2013 Elsevier Inc.
SDGs
Other Subjects
antimetabolite; azathioprine; calcineurin inhibitor; creatinine; cyclosporin; everolimus; mycophenolic acid 2 morpholinoethyl ester; rapamycin; steroid; tacrolimus; acute graft rejection; attenuation; cardiac allograft vasculopathy; cardiac graft rejection; cell differentiation; creatinine blood level; cytomegalovirus infection; diabetic patient; drug efficacy; drug exposure; graft failure; graft recipient; heart graft; heart transplantation; high risk patient; human; immunosuppressive treatment; intravascular ultrasound; kidney function; kidney preservation; lymphocele; maintenance therapy; memory T lymphocyte; multicenter study (topic); pericardial effusion; pleura effusion; postoperative complication; randomized controlled trial (topic); review; risk factor; surgical wound; wound complication; wound healing; Evidence-Based Medicine; Graft Rejection; Heart Transplantation; Humans; Immunosuppressive Agents; Postoperative Complications; Risk Factors; Sirolimus
Type
review