Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2017; 9(23): 990-1000
Published online Aug 18, 2017. doi: 10.4254/wjh.v9.i23.990
Use of everolimus in liver transplantation
Mei-Ling Yee, Hui-Hui Tan
Mei-Ling Yee, Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore
Hui-Hui Tan, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore
Author contributions: Both authors contributed to the writing and review of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mei-Ling Yee, Senior Principal Clinical Pharmacist, Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Telephone: +65-63213797 Fax: +65-62274330
Received: January 16, 2017
Peer-review started: January 18, 2017
First decision: May 9, 2017
Revised: May 20, 2017
Accepted: June 12, 2017
Article in press: June 13, 2017
Published online: August 18, 2017

In recent years, the use of mammalian target of rapamycin inhibitors has gained traction in their use as alternative or adjunct immunosuppressants in the post-liver transplantation (LT) setting. The efficacy of everolimus (EVR) in de novo LT is established and a reasonable time to initiate EVR is 30 d from LT surgery. Initiating EVR early post-LT allows for calcineurin inhibitor (CNI) reduction, thus reducing nephrotoxicity in LT recipients. However, data is inadequate on the appropriate timing for conversion from CNI to EVR maintenance in order to achieve optimal renoprotective effect without compromising drug efficacy. Adverse effects of proteinuria, hypercholesterolemia and hyperlipidemia are significantly higher as compared to standard CNI and long-term implications on graft and patient survival in LT is still unclear. Future research to explore strategies to minimise EVR adverse effects will be crucial for the success of EVR as an important alternative or adjunct immunosuppressive therapy in LT.

Keywords: Everolimus, Mammalian target of rapamycin inhibitor, Immunosuppression, Liver transplantation, Nephrotoxicity

Core tip: Everolimus is the most recently approved immunosuppressant for use in liver transplantation (LT). Its renoprotective effect is an attractive option for LT recipients who have calcineurin inhibitor-induced nephrotoxicity. This review examines through data published, discovers gaps of evidences and discusses the place in therapy for everolimus (EVR) in LT. At the end of review, it summarises how EVR can benefit LT recipients as well as the caveat in using EVR.