Korean J Transplant.  2019 Dec;33(4):98-105. 10.4285/jkstn.2019.33.4.98.

Cross-sectional analysis of immunosuppressive regimens focused on everolimus after liver transplantation in a Korean high-volume transplantation center

• Kang SH
• Hwang S
• Ha TY
• Song GW
• Jung DH
• Ahn CS
• Moon DB
• Kim KH
• Park GC
• Yoon YI
• Park YH
• Cho HD
• Kwon JH
• Chung YK
• Choi JU
• Lee SG

• KMID: 2468159
• DOI: http://doi.org/10.4285/jkstn.2019.33.4.98

Abstract

BACKGROUND
The mammalian target of the rapamycin inhibitor has dual inhibitory effects on cell growth and angiogenesis. This study aimed to analyze the usage of everolimus on actual immunosuppression (IS) regimens through a cross-sectional study in a high-volume liver transplantation (LT) center.
METHODS
Our institutional LT database was searched for adult patients who underwent primary LT surgery between January 2010 and December 2016. We identified 2,093 LT recipients with observation periods of 1 to 8 years.
RESULTS
We divided the 2,093 recipients into three groups according to the posttransplant follow-up period as follows: group A (12-36 months; n=680), group B (37-60 months; n=560), and group C (>60 months; n=853). The individual IS agents were tacrolimus in 1,807 patients (86.3%), cyclosporine in 169 patients (8.1%), mycophenolate mofetil (MMF) in 1,310 patients (62.6%), and everolimus in 115 patients (5.5%). The most common IS regimens were tacrolimus-MMF combination and tacrolimus monotherapy, regardless of the posttransplant period. Patients with pretransplant malignancies were administered everolimus more frequently than those without pretransplant malignancies (P<0.001). In 102 patients with hepatocellular carcinoma recurrence or de novo malignancies, IS regimens included everolimus-tacrolimus in 41 patients (40.2%), tacrolimus-MMF in 27 patients (26.4%), tacrolimus in 20 patients (19.6%), MMF in 10 patients (9.8%), cyclosporine in three patients (2.9%), and cyclosporine-MMF in one patient (1.0%).
CONCLUSIONS
Administration of everolimus after LT has been gradually increasing with the expansion of indications in our institutional practice. Currently, the role of everolimus is minimal and not comparable to that of tacrolimus, but it has a unique position in the field of IS after LT.

Keyword

Tacrolimus; Mycophenolate mofetil; Everolimus; Malignancy; Hepatocellular carcinoma

MeSH Terms

Adult
Carcinoma, Hepatocellular
Cross-Sectional Studies*
Cyclosporine
Everolimus*
Follow-Up Studies
Humans
Immunosuppression
Institutional Practice
Liver Transplantation*
Liver*
Recurrence
Sirolimus
Tacrolimus
Cyclosporine
Everolimus
Sirolimus
Tacrolimus

Figure

• 

  Fig. 1 Proportion of immunosuppressive regimens in 2,093 liver transplant recipients according to posttransplant periods. F, tacrolimus; C, cyclosporine; M, mycophenolate mofetil; T, everolimus. Letters indicate the combination therapy.

• 

  Fig. 2 Proportion of immunosuppressive regimens in liver transplant recipients with or without pretransplantation liver malignancies. F, tacrolimus; C, cyclosporine; M, mycophenolate mofetil; T, everolimus. Letters indicate the combination therapy.

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