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Original Article

Korean J Transplant 2019; 33(4): 98-105

Published online December 31, 2019

https://doi.org/10.4285/jkstn.2019.33.4.98

© The Korean Society for Transplantation

Cross-sectional analysis of immunosuppressive regimens focused on everolimus after liver transplantation in a Korean high-volume transplantation center

Sang-Hyun Kang1, Shin Hwang1, Tae-Yong Ha1, Gi-Won Song1, Dong-Hwan Jung1, Chul-Soo Ahn1, Deok-Bog Moon1, Ki-Hun Kim1, Gil-Chun Park1, Young-In Yoon1, Yo-Han Park2, Hui-Dong Cho1, Jae-Hyun Kwon1, Yong-Kyu Chung1, Jin Uk Choi1, Sung-Gyu Lee1

1Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;
2Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Shin Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3930, Fax: +82-2-3010-6701 E-mail: shwang@amc.seoul.kr

Received: August 7, 2019; Revised: September 16, 2019; Accepted: October 11, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The mammalian target of the rapamycin inhibitor has dual inhibitory effects on cell growth and angiogenesis. This study aimed to analyze the usage of everolimus on actual immunosuppression (IS) regimens through a cross-sectional study in a high-volume liver transplantation (LT) center.
Methods: Our institutional LT database was searched for adult patients who underwent primary LT surgery between January 2010 and December 2016. We identified 2,093 LT recipients with observation periods of 1 to 8 years.
Results: We divided the 2,093 recipients into three groups according to the posttransplant follow-up period as follows: group A (12–36 months; n=680), group B (37–60 months; n=560), and group C (>60 months; n=853). The individual IS agents were tacrolimus in 1,807 patients (86.3%), cyclosporine in 169 patients (8.1%), mycophenolate mofetil (MMF) in 1,310 patients (62.6%), and everolimus in 115 patients (5.5%). The most common IS regimens were tacrolimus-MMF combination and tacrolimus monotherapy, regardless of the posttransplant period. Patients with pretransplant malignancies were administered everolimus more frequently than those without pretransplant malignancies (P<0.001). In 102 patients with hepatocellular carcinoma recurrence or de novo malignancies, IS regimens included everolimus-tacrolimus in 41 patients (40.2%), tacrolimus-MMF in 27 patients (26.4%), tacrolimus in 20 patients (19.6%), MMF in 10 patients (9.8%), cyclosporine in three patients (2.9%), and cyclosporine-MMF in one patient (1.0%).
Conclusions: Administration of everolimus after LT has been gradually increasing with the expansion of indications in our institutional practice. Currently, the role of everolimus is minimal and not comparable to that of tacrolimus, but it has a unique position in the field of IS after LT.

Keywords: Tacrolimus, Mycophenolate mofetil, Everolimus, Malignancy, Hepatocellular carcinoma