Clinical Medicine Reviews in Therapeutics

Everolimus (ERL) is a recently developed mTOR inhibitor. This rapamycin analog is used to prevent acute rejection during kidney and heart transplantation. We review here published clinical trials and experiences concerning potential applications of ERL in liver and lung transplantation. Most of the data concern conversion for rescue situations, but a small number of studies have been conducted in de novo patients. In most cases, everolimus was used to spare renal function and to minimize calcineurine inhibitor use, but also, due to the antiproliferative properties of the drugs of this class, to control malignancy. Safety issues are an important consideration when deciding whether to maintain a patient on treatment. Therapeutic drug monitoring is strongly recommended, to achieve a mean whole-blood trough concentration of 6 ng/mL, with doses of 0.5 to 1.5 mg administered twice daily. There is solid evidence that ERL is a feasible and effective treatment, for a selected subset of patients, in the contexts of liver and lung transplantation.