Everolimus Use for Intolerance or Failure of Baseline Immunosuppression in Adult Heart and Lung Transplantation
| Autor: | Reda E. Girgis, Michael G. Dickinson, Shelby Kelsh, Jennifer K McDermott |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty medicine.medical_treatment Bronchiolitis obliterans Neutropenia 030226 pharmacology & pharmacy Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Lung transplantation Humans Renal Insufficiency Everolimus Retrospective Studies Heart transplantation Immunosuppression Therapy Transplantation Original Paper Leukopenia business.industry Immunosuppression General Medicine Middle Aged medicine.disease Treatment Outcome Tolerability 030220 oncology & carcinogenesis Heart Transplantation Female medicine.symptom business Immunosuppressive Agents medicine.drug Lung Transplantation |
| Zdroj: | Annals of Transplantation |
| ISSN: | 2329-0358 1425-9524 |
| Popis: | BACKGROUND Everolimus can be utilized after heart or lung transplantation to reduce calcineurin inhibitor associated nephrotoxicity, due to cell cycle inhibitor adverse effects, and as adjunct therapy for rejection, cardiac allograft vasculopathy, and bronchiolitis obliterans syndrome. MATERIAL AND METHODS A single-center, retrospective cohort study was conducted including 51 adult heart transplant patients (n=32) and lung transplant patients (n=19) started on everolimus due to immunosuppressive therapy intolerance or failure, between 2010 and 2017. Everolimus indication, response, efficacy, and tolerability were assessed. RESULTS Everolimus was most commonly initiated due to leukopenia/neutropenia (n=17, 33%) or renal dysfunction (n=13, 25%). Leukopenia/neutropenia resolved in 76% of patients (13 out of 17 patients). Renal function (GFR) increased 7.4 mL/min from baseline to 3 months after everolimus initiation (P=0.011). The most common adverse effects were edema (n=23, 45%) and hyperlipidemia (n=25, 49%). A high discontinuation rate was observed (n=21, 41%), mostly from edema. CONCLUSIONS Everolimus might be beneficial in heart and lung transplant patients with leukopenia or neutropenia and lead to modest, short-term renal function improvement. Patient selection is crucial because adverse effects frequently lead to everolimus discontinuation. |
| Databáze: | OpenAIRE |
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