Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now?

Zuckermann, Andreas; Wang, Shoei-Shen; Epailly, Eric; Barten, Markus J; Sigurdardottir, Vilborg; Segovia, Javier; Varnous, Shaida; Turazza, Fabio M.; Potena, Luciano; Lejmkuhl, Hans B. (2013). Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now? Transplantation Reviews, 27(3), pp. 76-84. W.B. Saunders 10.1016/j.trre.2013.03.002

	Text Transpl_Rev_2013_EVR_Sigurdardottir.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (301kB) | Request a copy
Preview	Text Zuckermann_2013_last revision.pdf - Accepted Version Available under License Publisher holds Copyright. Download (1MB) | Preview

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.

Interest & Impact

Downloads

298 since deposited on 19 Mar 2014
39 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item