• Michał P Wasilewicz, Dorota Moczydłowska, Maciej Janik, Michał Grąt, Krzysztof Zieniewicz, and Joanna Raszeja-Wyszomirska.
• Department of Hepatology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland; Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland; Department of Hematology with Bone Marrow Transplantation Unit, Pomeranian Medical University in Szczecin, Szczecin, Poland. newdodo@poczta.onet.pl
• Pol. Arch. Med. Wewn. 2019 Oct 30; 129 (10): 686-691.

IntroductionEverolimus after liver transplant (LT) has been used to minimize the use of calcineurin inhibitors (CNIs), optimize renal function, and prevent recurre nce of hepatocellular carcinoma (HCC).ObjectivesWe aimed to analyze a single‑center experience with switching from CNIs to everolimus in immunossupressive treatment of LT recipients.Patients And MethodsA total of 108 LT recipients (men, 65.7%; mean [SD] age, 53.2 [11.1] years) were prospectively enrolled into the study. In all patients, everolimus and CNIs were introduced (target trough levels of 3 to 6 ng/ml and 3 to 5 ng/ml, respectively). After 3 months, CNIs were discontinued in patients who tolerated everolimus well, while everolimus dosage was increased (blood trough levels, 6-12 ng/ml).ResultsEverolimus monotherapy was introduced in 32 patients (29.6%), while a combination therapy with everolimus and CNIs was continued in 76 patients (70.4%). However, during a mean follow‑up of 27 months (range, 4-50 months), everolimus was withdrawn in 25 patients (33%) due to side effects. In the everolimus‑monotherapy group, all patients continued the therapy (P <0.005), but dyslipidemia was more frequent than in patients receiving everolimus and CNIs (40.6% vs 14.5%; P <0.03). Creatinine levels improved significantly in both groups: combination therapy, from 1.58 mg/dl to 1.24 mg/dl after 3 months, and everolimus monotherapy, from 1.19 mg/dl to more than 1 mg/dl. Renal function in the everolimus group was better than in the combination-therapy group (P <0.04). Recurrence of HCC was observed in both groups: combination therapy (9/46 [19.6%]) and everolimus monotherapy (1/17 [5.9%]; P <0.01).ConclusionsThis study showed that switching from CNIs to everolimus after LT allowed a safe weaning of CNIs and an improvement in creatinine levels. In patients on everolimus monotherapy, we observed dyslipidemia as a dose‑dependent side effect of the drug as well as a lower risk of HCC recurrence.

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