Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant

Pil Soo Sung, Ji Won Han, Changho Seo, Joseph Ahn, Soon Kyu Lee, Hee Chul Nam, Ho Joong Choi, Young Kyoung You, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon

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3 Scopus citations

Abstract

Background: Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus and sirolimus, may be efficacious in preserving renal function in liver transplantation (LT) recipients while preventing hepatocellular carcinoma (HCC) recurrence. Materials and Methods: In this study, we retrospectively evaluated the safety, efficacy, and renoprotective effects of mTOR inhibitors in LT recipients. Among the 84 patients enrolled, mTOR inhibitor was commenced during the first year after LT. Renal function was measured by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Results: Regarding the type of mTOR inhibitor, everolimus was used in 71 patients and sirolimus in 13 patients. Concomitant tacrolimus was used in 63 patients (75.0%). For total enrolled patients, kidney function did not significantly change during 12 months after initiation of mTOR inhibitors, although tacrolimus-withdrawn patients (n = 21) showed better kidney function compared to tacrolimus-minimized patients (n = 63) after conversion. However, a significant improvement in kidney function was observed in the eGFR <60 ml/min/1.73 m2 group (n = 19) 12 months after initiation of mTOR inhibitors, for both patient groups with early + mid starters (n = 7, stating within 1 year after LT) and late starters (n = 12, starting over 1 year after LT). mTOR inhibitors were safely administered without serious adverse events that led to drug discontinuation. Conclusion: We demonstrated that patients with renal impairment showed significant improvement in renal function regardless of the timing of mTOR inhibitor start, suggesting that switch to mTOR inhibitors may be beneficial when renal function declines.

Original languageEnglish
Article number685176
JournalFrontiers in Pharmacology
Volume12
DOIs
StatePublished - 13 Jul 2021

Bibliographical note

Funding Information:
This work was supported by the Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea. The authors also acknowledge the financial support of the Catholic Medical Center Research Foundation in the program year of 2020. This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2021R1C1C1005844 to PS).

Publisher Copyright:
© Copyright © 2021 Sung, Han, Seo, Ahn, Lee, Nam, Choi, You, Jang, Choi and Yoon.

Keywords

  • calcineurin inhibitor
  • liver transplantation
  • living donation
  • mTOR inhibitor
  • renal dysfunction

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