Everolimus - retrospective analysis of therapy with mTor-inhibitors of 38 patients after pediatric HTX

Introduction: Beside the avoidance of a rejection the minimization of side effects of the immunosuppressive therapy is one of the most important aims in the follow up after pediatric heart transplantation. Due to their low nephrotoxic and their antiproliferative effect mTor-inhibitors are getting more and more a component of the standard immunosuppressive therapy after pediatric heart transplantation.

Methods: Retrospective analysis of all of our patients under immunosuppressive therapy with everolimus. We focused on the reasons for changing the therapy to everolimus and on the side effects that led to an interruption or termination of the therapy with everolimus.

Results: Between 2007 and 2012 the immunosuppressive therapy of 38 patients (55% of all patients) after pediatric heart transplantation was switched to everolimus. The three main causes were vasculopathy (37%), renal insufficiency (26%) and gastrointestinal problems (18%). 29% of the patients (n = 11) discontinued the treatment with everolimus, mostly due to leukopenia (n = 4), atopic eczema (n = 3) and stomatitis (n = 2). 64% of the patients tolerated everolimus good after a second try. Two of 28 patients with proven preexisting vasculopathy showed a regression of the vasculopathy under everolimus. Six months after switch to everolimus five patients showed a regression of the creatinine clearance more than 10%. None of the patients had a rejection under everolimus.

Conclusions: A therapy with everolimus is a safe possibility after pediatric heart transplantation, especially in patients with vasculopathy, renal insufficiency and gastrointestinal problems.