실제 임상현장에서의 간이식 환자 대상 Everolimus와 저용량 Tacrolimus 병용요법의 유효성 및 안전성 평가

• Published in: 한국임상약학회지 Vol. 31; no. 1; pp. 44 - 52
• Main Authors: 장서윤, 김보람, 전수정, 최경숙, 이은숙, 이주연, 김은경, 한호성, 조재영, Jang, Seoyoun, Kim, Boram, Jeon, Sujeong, Choi, Kyung Suk, Lee, Eunsook, Lee, Ju-Yeun, Lee, Euni, Han, Ho-Seong, Cho, Jai Young
• Format: Journal Article
• Language: Korean
• Published: 한국임상약학회 31.03.2021
• Subjects: 약학; Everolimus; tacrolimus; safety; liver transplantation; efficacy
• ISSN: 1226-6051; 2508-786X
• DOI: 10.24304/kjcp.2021.31.1.44

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions: In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.