Everolimus is Associated With Less Weight Gain Than Tacrolimus 2 Years Following Liver Transplantation: Results of a Randomized Multicenter Study.

Background: Weight gain early after transplant is a risk factor for posttransplant metabolic syndrome (PTMS), cardiovascular events, and renal insufficiency. The impact of mTOR inhibition on posttransplant weight gain and the development of PTMS components postliver transplantation were examined in a randomized, controlled study. Methods: Following a run-in period, patients (N = 719) were randomized at 30+/-5 days posttransplant in a 1:1:1 ratio to 3 treatment groups: (i) everolimus (EVR) + reduced tacrolimus (TAC)(n=245); (ii) TAC control (n=243) or (iii) TAC elimination (n=231). In this posthoc analysis, weight change at 12 and 24 months was compared between groups. Vital signs, lipids and laboratory parameters at 12 and 24 months and rates of PTMS were assessed. Results: Mean increase in weight from baseline was higher at month 12 in the TAC control arm (8.15 +/- 9.27 kg) than in the EVR + reduced TAC (5.88 +/- 12.60 kg, P=0.056) and the TAC elimination arms (4.76 +/- 9.94 kg, P=0.007). At month 24, the TAC control arm displayed a significantly greater weight increase (9.54 +/- 10.21 kg) than either the EVR + reduced TAC (6.69 +/- 8.37 kg, P=0.011) or the TAC elimination groups (6.01 +/- 9.98 kg, P=0.024). Rates of PTMS were similar for the EVR + reduced TAC (71.8%), TAC elimination (70.3%) and TAC control (67.4%) arms (P=NS). Conclusions: EVR with reduced-exposure TAC attenuated weight gain at 1 and 2 years posttransplant compared to a standard tacrolimus immunosuppression regimen. Rates of PTMS were comparable between EVR-containing and TAC control regimens. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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