181 TREATMENT WITH PEGYLATED INTERFERON AND RIBAVIRIN DURING EARLY ACUTE PHASE OF THE HEPATITIS C RECURRENCE VS LATE HEPATITIS C RECURRENCE AFTER LIVER TRANSPLANTATION

Abstract

Aim: Everolimus (Ever) is an mTor inhibitor with immunosuppressant indication on renal and cardiac transplantation. The objetive of this study is to analyze the uses and management on liver transplantation (LT). Material and Methods: Since October 1988 to July 2011, 972 liver transplantations were performed in our center. Seventy-four (7.6%) have received Everolimus. Demographic characteristics of these patients, indication and timing of conversion, the evolution and mean follow-up after conversion, the adverse events and withdrawal rate have been analyzed. Results:Mean age at time of conversion was 58±10 years (r: 27–74). The indications of conversion were: refractory rejection 22(29.7%); HCC out of Milan criteria in explanted liver 13(16.6%); HCC recurrence post-LT 6(8.1%); “de novo” Tumor 13(17.6%); post-LT renal insufficiency 7(9.5%); neurotoxicity 9 (12.2%) and others 4(5.4%). Mean time from LT to conversion was 26±42 months (r: 0.5–160), median 6m. Mean follow-up post-conversion was 15±14 (r: 0.5–56), median12 months. At time of conversion, 19 patients suffered renal insufficiency, 25 arterial hypertension, 21 diabetes mellitus and 29 hyperlipidemia. Preconversion immunosuppressant regimen was based on: 69 Tacrolimus, 4 Cyclosporin y 1 MMF. Postconversion regimen was Tacrolimus+Ever 53; Cyclosporine+Ever 4; Ever±MMF±steroids 10; Ever±steroids 7. Mean trough levels were arround 3ng/ml. Out of the 74 patients, 51 (69%) resolved the cause of conversion. More than half of the patients with renal insufficiency and 7 out of 21 patients with diabetes mellitus ameliorated the basal status. The main adverse event was hyperlipidemia (42%). Thirteen patients withdrew the drug due to inefficiency (7) and resolution of adverse event (6). Conclusion: Everolimus at low doses (trough levels around 3ng/ml), in combination with Tacrolimus or Cyclosporin is a safe and efficient immunosuppressant with multiples indications in early and late post-LT period.