Safety and Efficacy of Everolimus Use to Preserve Renal Function in Intestinal and Multivisceral Transplantation Patients

Abstract

Background

As calcineurin inhibitors are associated with renal impairment post intestinal transplant, use of everolimus (EVR) may provide renal-sparing benefits.

Methods

We performed a retrospective analysis focused on EVR use and renal function after intestinal or multivisceral transplant. No prisoners were used in the study. This study is compliant with the Helsinki Congress and the Declaration of Istanbul.

Results

A total of 28 patients, 18 patients who underwent isolated intestinal transplant, and 10 patients who underwent multivisceral transplant, were included in this study. For 13 patients that never received EVR, the average change in estimated glomerular filtration rate (eGFR) compared to baseline at the time of transplant were as follows: 1 year post-transplant = –18.1%; 2 years = –43.7%; 3 years = –44.1; and 5 years = –43.3%. For 15 patients who received EVR after transplant, average duration of EVR therapy was (579.60 ± 784.15) days with 87% of patients ultimately removed from medication due to side effects. In the EVR group, the average change in eGFR compared to baseline were as follows: 1 year post-transplant = –37.5%; 2 years = –43.5%; 3 years = –54.2%; and 5 years = –42.9%. After the initiation of EVR, the average change in eGFR compared to eGFR at time of EVR initiation was as follows: 1 year = +5.9%; 2 years = –1.57%; 3 years = –5.01%; and 5 years = –1.79%.

Conclusions

This study suggests that EVR can play an important role in preserving renal function in intestinal and multivisceral transplant recipients, but tolerance of EVR is highly variable in this patient population.