Early Use of Everolimus as a Third Immunosuppressive Agent for Intestinal Transplantation: A Report of 2 Cases |
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| Institution: | 1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan;2. Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan;1. Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;2. Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;3. Department of General Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;4. Department of Gastroenterology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;5. Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;1. Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea;2. Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea;1. Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea;2. Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea;1. Department of Surgery, Incheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Department of Surgery, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;1. Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;2. Transplant Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;3. Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;4. Division of Transplant Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Shinjuku Ward, Tokyo, Japan;5. Department of Nephrology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;1. Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan;2. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan |
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| Abstract: | BackgroundIn patients with intestinal transplantation (ITx), renal function is easily impaired because of long-term parenteral nutrition and side effects of tacrolimus. Everolimus was used in patients with renal insufficiency in our study.MethodsWe administered everolimus as a third immunosuppressive agent in addition to tacrolimus and steroids for renal sparing in patients who received ITx. We assessed everolimus levels, complications, and renal function.ResultsTwo patients received everolimus after ITx. Patient 1 was a 13-year-old boy who underwent ITx for an allied disorder of Hirschsprung's disease. After induction therapy with rabbit antithymocyte globulin, maintenance therapy consisted of tacrolimus and steroids. Everolimus was introduced 3 months after ITx for renal sparing. Seven months later, the patient required partial intestinal graft resection owing to bowel obstruction. Everolimus was suspended for only 2 weeks. Four years after ITx, the trough level of tacrolimus was maintained at 3 to 5 ng/mL. The trough level of everolimus was maintained at 3 to 5 ng/mL. Patient 2 was a 32-year-old man who underwent deceased ITx for short gut syndrome. Induction and maintenance immunosuppression was the same as for patient 1. Everolimus was introduced 1 month after surgery. Two years after ITx, trough levels of tacrolimus and everolimus were the same as in patient 1. No rejection was observed in either patient, and renal function was well maintained. We observed no side effects caused by everolimus.ConclusionsEverolimus could be used safely and effectively after ITx. Early use of everolimus after ITx did not affect wound healing. |
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