EVEROLIMUS-BASED IMMUNOSUPPRESSION IS ASSOCIATED WITH A REDUCED RISK OF NEW- ONSET MALIGNANCIES AFTER LIVER TRANSPLANTATION

Background and Aim: The inhibitor of the mammalian target of rapamycin (mTOR) everolimus (EVR) has shown anti-proliferative effects in experimental and clinical models. We investigated whether liver transplant (LT) recipients on EVR-based immunosuppression had comparable outcome in terms of the incidence of new-onset post-transplant malignancies (NOPTM ) versus patients receiving calcine urin inhibitors(CNI). Materials and methods: This was a retrospective analysis of as ingle-center, prospectively collected database. Between January 1996 and December 2013, 1,510 LT procedures were performed on 1437 patients. A total of 243 patients received EVR for reasons other than denovo or recurrent malignancies and were compared against 1182 patients on CNI-based immunosuppression (total dataset = 1425 patients). Data were censored until occurrence of NOPTM, death, lost to follow-up or as of November 2014. Results: At a median follow-up of 1740 days (range 1–6510), a total of 43 NOPTM was observed (3.01%). Two (0.8%) NOPTM were observed in the EVR group (median follow-up 1050 days; range 7– 2880) (1 skin cancer, 1 post- transplant lymphoproliferative disease (PTLD)) versus 41 (3.4%) in patients on CNI (median follow-up 3121 days (range 1–6510) (11 skin cancers; 7 PTLD; 23 solidorgan) (p = 0.031). Being older at transplantation, higher CNI exposure, Epstein-Barr virus negative status at transplantation, and no exposure to EVR were independent risk factors for NOPTM. Conclusions: EVR utilization was associated with a reduced risk for NOPTM after LT. To the best of our knowledge, this is the first evidence to be reported for EVR-based immunosuppressive regimens