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Anti-rejection Drug Everolimus Could Improve Outcomes for Liver Transplant Recipients

Anti-rejection Drug Everolimus Could Improve Outcomes for Liver Transplant Recipients

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  • Anti-rejection drugs are prescribed after transplantation to prevent the immune system from attacking and destroying the transplanted organ.
  • Commonly prescribed anti-rejection drugs may lead to weight gain, thereby increasing the risk of serious complications.
  • A study has found that a anti-rejection drug called Everolimus may prevent weight gain after transplantation and reduce complications.

Liver transplantation is a surgical procedure that replaces a patient's diseased liver with a whole or partial healthy liver from a healthy donor. Patients who undergo liver transplant are likely to experience weight gain, which is common after surgery and can lead to serious complications. A research team from the Intermountain Medical Center Transplant Program in Salt Lake City found that an anti-rejection drug called Everolimus can reduce weight gain after liver transplant and prevent complications.

The research team conducted a randomized international multicenter study along with Northwestern University, Novartis Pharmaceuticals Corp., and Mayo Clinic. The study involved more than 700 patients.


Complications after Liver Transplant

Patients who undergo liver transplant experience weight gain, which can consequently lead to serious complications such as cardiovascular events, and post-transplant metabolic syndromes such as diabetes, obesity, high blood pressure and hyperlipidemia.

Anti-rejection Medications

Patients who undergo a transplant must take anti-rejection drugs so that their immune systems do not attack and destroy the transplanted organ. Tacrolimus is an anti-rejection drug routinely prescribed post transplant. Studies have shown that Tacrolimus can affect the kidneys and cause weight gain, which heightens the risk of serious complications.

Comparison between Two Anti-rejection Medications

The research team conducted a comparison study among two anti-rejection drugs. In the study published in the American Journal of Transplantation, a new drug called Everolimus was compared to Tacrolimus in reducing complications after liver transplant.

Previously conducted studies have shown that Everolimus prevented weight gain in fruit flies and other animals. So an experimental study was conducted on human subjects to check whether the effects were the same.

Initially, the research was undertaken to see if Everolimus is gentler on the kidneys than Tacrolimus. The study involved a total of 719 patients between 25 and 35 days after liver transplant. The participants were divided into three groups.
  • The first group had 243 patients who received Everolimus and a reduced dose of Tacrolimus
  • The second group served as a control group that had 243 patients who received the usual dose of Tacrolimus
  • The third group had 231 patients who were prescribed only Everolimus to suppress their immune systems
The findings showed that liver transplant patients in the first (Everolimus and Tacrolimus) and third (Everolimus) group gained 10 pounds less than those in the second group (Tacrolimus). The research team also found that the reduced weight gain was seen both one and two years after transplant. Everolimus has been approved as an immunosuppressive agent by the Food and Drug Administration for use in liver transplantation.

"Everolimus did have less impact on kidney function, and the Food and Drug Administration approved the drug based on that finding for use in liver transplant patients," said Dr Michael M. Charlton, researcher and clinician at the Intermountain Medical Center Center Transplant Program, and the study's lead author.

Organ rejection used to be the primary cause of death after transplantation. But now, the common cause of death following liver transplantation is related to kidney function, cardiovascular events and cancers. Cardiovascular disease, cancers and kidney damage are driven by weight gain, according to Dr. Charlton.

One of the reasons that people need liver transplant today is the weight-related liver failure. "Since nearly everyone who receives a liver transplant gains weight after the surgery, this could be an easy way to avoid or limit the need for a transplant," said Dr, Charlton.

Reference :
  1. Everolimus in liver transplantation - (https://www.ncbi.nlm.nih.gov/pubmed/25254569)
Source: Medindia

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