Everolimus Plus Advagraf in Liver Transplanted Patients for HCC: Single Center Experience, One Year Follow-Up

Résumé fourni par la source

The inhibitor of mTOR (everolimus) has the potential to reduce calcineurin inhibitor (CNI) exposure after liver transplantation avoiding several possible comorbidities. Particularly it may de used in patients transplanted for HCC on ESLD, due to the potential antitumoral activity. Data on combined therapy with Everolimus and once a day tacrolimus treatment (ADVAGRAF) are sparse. Aim of the present study was to evaluate Everolimus coupled to minimized Advagraf therapy in patients underwent liver transplant. We enrolled and followed for at least 12 months 20 patients (16M/4F), the mean time from transplantation to the introduction of everolimus and advagraf was 4±2 months. All subjects were previously on tacrolimus twice a day (0.01mg/kg). We decided to maintain the total through level in the blood of the two drugs 10-12. Results: The mean everolimus trough level was 5.5 ± 2.4 ng/mL at month 1 while Advagraf was 2.5 ± 2.1 ng/mL. We had two episodes of reject (one month after the introduction of the dual therapy) treated increasing CNI dose. Patients having reject had a total trough level of 8. The mean estimated glomerular filtration rate (eGFR) according to the MDRD formula was 60.2 ± 30.0 mL/minute on day 0 and 62.4 ± 32.5 mL/minute at month 12 (P = 0.005). Adverse events led to everolimus discontinuation (three months after introduction therapy) in two of the patients was related to severe aftosis. After the initiation of everolimus, the mean white blood cell count decreased significantly, and the total cholesterol and triglyceride levels increased significantly (p< .05). Conclusion: In conclusion, the use of a combined therapy with everolimus and advagraf, maintening a total trough level of 10-12, seem to be safe and without significant adverse effects on renal function

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