Everolimus is safe within the first month after liver transplantation

Rodríguez‐Perálvarez, Manuel; Pérez-Medrano, Indhira; Guerrero-Misas, Marta; González, Víctor; Poyato, Antonio; Barrera, Pilar; Ferrín, Gustavo; Pozo, Juan C.; Sánchez-Frías, Marina; Ciria, Rubén; Briceño, Javier; Montero, J.L.; Mata, Manuel de la

doi:10.1016/j.trim.2015.09.002

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…A retrospective chart review of a larger cohort of patients who received EVR‐based IS revealed a significantly higher incidence of thromboembolic complications among those patients treated with EVR than among those treated with extended‐release TAC; however, on average, the manifestation of clinical problems did not occur earlier than a year after conversion. This finding is not reflected by previous studies …”

Section: Discussioncontrasting

confidence: 99%

“…Furthermore, Rodríguez‐Perálvarez et al found that the incidence of vascular complications was not higher among patients treated with EVR within the first month after LT (n = 33) or later (n = 25) . However, in both studies, the patient groups treated with EVR were smaller, and the observational period was short …”

Section: Discussionmentioning

confidence: 96%

“…(35) Furthermore, Rodríguez-Perálvarez et al found that the incidence of vascular complications was not higher among patients treated with EVR within the first month after LT (n = 33) or later (n = 25). (34) However, in both studies, the patient groups treated with EVR were smaller, and the observational period was short. (34,35) Further factors that might increase the risk for thromboembolic events for EVR patients versus TAC patients, such as arterial hypertension (38.3% versus 50.0%; P = 0.15), corticosteroids (10.6% versus 22.9%; P = 0.05), or increased cholesterol levels (168.3 ± 42.3 versus 184.6 ± 40.9 mg/dL; P = 0.02), were also more often observed in those patients who did not receive EVR, as depicted in Supporting Table 1.…”

Section: Original Article | 1063mentioning

confidence: 95%

“…This finding is not reflected by previous studies. (34,35) For example, Jeng et al found no instances of hepatic artery thrombosis over a period of 9 ± 6 months among 43 patients who had undergone living donor LT and had been treated with EVR in combination with calcineurin inhibitors. (35) Furthermore, Rodríguez-Perálvarez et al found that the incidence of vascular complications was not higher among patients treated with EVR within the first month after LT (n = 33) or later (n = 25).…”

Section: Original Article | 1063mentioning

confidence: 99%

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The Effect of Immunosuppression on Coagulation After Liver Transplantation

et al. 2019

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Everolimus (EVR) is a mammalian target of rapamycin (mTOR) inhibitor commonly used for immunosuppression (IS) after liver transplantation (LT). However, there are concerns about whether mTOR inhibitors may move the hemostatic balance toward a higher likelihood of thrombosis. The present study aimed to investigate potential coagulation disorders after the administration of EVR. We evaluated 54 patients after conversion to an EVR‐based IS regimen (n = 26) and compared those patients with patients who were switched to extended‐release tacrolimus (TAC) but had never received EVR (n = 28). At baseline and again at 1 month and 6 months after conversion, we measured international normalized ratio, activated partial thromboplastin time, and anticoagulation and fibrinolysis factors, and we performed rotational thromboelastometry (ROTEM). Data were analyzed with a Mann‐Whitney U test, a repeated‐measure analysis of variance, and a Fisher’s exact test. Statistical significance was set at the level of P ≤ 0.05. Plasma levels of von Willebrand factor, fibrinogen, and factor VIII were significantly higher than baseline levels at 1 month and 6 months after conversion of IS to EVR (P < 0.001); plasma levels of protein C, protein S, and plasminogen also increased significantly (P < 0.001). ROTEM confirmed a significant increase in maximum clot firmness in EXTEM, INTEM, and FIBTEM assays (P < 0.001). In all assays, maximum lysis was significantly lower than baseline levels at 1 month and 6 months after conversion to EVR. Patients converted to IS with extended‐release TAC exhibited no significant changes in coagulation variables. Retrospective analysis showed a significantly higher incidence of thromboembolic complications among patients treated with EVR‐based IS than among those treated with extended‐release TAC (P < 0.01). In conclusion, the administration of EVR after LT seems to modify hemostasis to a procoagulant state. Thrombophilia screening before conversion may determine which patients will benefit from conversion to EVR‐based IS.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Original Article | 1063mentioning

confidence: 95%

Section: Original Article | 1063mentioning

confidence: 99%

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The Effect of Immunosuppression on Coagulation After Liver Transplantation

et al. 2019

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“…Interestingly, renal transplant patients with DES had a low rate of ST, probably related to the immunosuppressants given to prevent kidney rejection[77]. Everolimus has also been approved by the FDA for use in liver transplantation (LT), and is safe for use with tacrolimus within the first month after LT[78]. …”

Section: Post Transplant Immunosuppressionmentioning

confidence: 99%

Organ transplantation and drug eluting stents: Perioperative challenges

Dalal¹

2016

WJT

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Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.

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Liver Transplantation for the Nonhepatologist

Reddy

2023

Medical Clinics of North America

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Everolimus is safe within the first month after liver transplantation

Cited by 9 publications

References 26 publications

The Effect of Immunosuppression on Coagulation After Liver Transplantation

The Effect of Immunosuppression on Coagulation After Liver Transplantation

Organ transplantation and drug eluting stents: Perioperative challenges

Liver Transplantation for the Nonhepatologist

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