Purpose of review: In this review, we discuss the mechanism of action, side-effects, and role of everolimus (EVR) in liver transplant, specifically the most recent de-novo (within 1 month of transplant) and conversion (months to years after transplant) trials in the literature.
Recent findings: Everolimus was recently approved by the Food and Drug Administration for use in liver transplantation. Its primary benefit over other immunosuppressive agents is the absence of renal toxicity. De-novo liver recipients receiving EVR with reduced-dose tacrolimus had similar rates of death, graft loss, and rejection compared with tacrolimus monotherapy, but significantly better renal function. The most common side effects are manageable and include stomatitis, hyperlipidemia, and cytopenias. Compared with the other mammalian target of rapamycin inhibitor, sirolimus, EVR is not associated with impaired wound healing or hepatic artery thrombosis. In addition, EVR may provide some benefit as an antineoplastic agent that may be particularly applicable to liver recipients with hepatocellular carcinoma.
Summary: Everolimus is the only Food and Drug Administration-approved mammalian target of rapamycin inhibitor for liver transplantation. It offers noninferior immunosuppression (compared with standard therapy) with the absence of renal toxicity. Its use will likely increase over time as clinicians become more familiar with this drug.