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Journal of Transplantation
Volume 2013, Article ID 683964, 12 pages
Review Article

Everolimus in Heart Transplantation: An Update

1Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
2Division of Cardiovascular,Thoracic and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
3Department of Cardiac Surgery, University Hospital Leipzig, Heart Center, 04289 Leipzig, Germany
4Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistr 52, 20246 Hamburg, Germany
5Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
6Department of Cardiac Surgery, Munich Transplantation Center, Klinikum Großhadern LMU, Marchioninistraße 15, 81377 Munich, Germany
7Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstraße 11, 32545 Bad Oeynhausen, Germany
8Department of Cardiovascular Medicine, Division of Cardiology, Münster University Hospital, Albert-Schweitzer-Straße 33, 48149 Münster, Germany
9Department of Cardiovascular Surgery, University Hospital Kiel, Arnold-Heller-Straße 7, 24105 Kiel, Germany
10Department of Cardiovascular and Thoracic Surgery, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

Received 3 August 2013; Revised 27 September 2013; Accepted 29 September 2013

Academic Editor: Eric Thervet

Copyright © 2013 Stephan W. Hirt et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The evidence base relating to the use of everolimus in heart transplantation has expanded considerably in recent years, providing clinically relevant information regarding its use in clinical practice. Unless there are special considerations to take into account, all de novo heart transplant patients can be regarded as potential candidates for immunosuppression with everolimus and reduced-exposure calcineurin inhibitor therapy. Caution about the use of everolimus immediately after transplantation should be exercised in certain patients with the risk of severe proteinuria, with poor wound healing, or with uncontrolled severe hyperlipidemia. Initiation of everolimus in the early phase aftertransplant is not advisable in patients with severe pretransplant end-organ dysfunction or in patients on a left ventricular assist device beforetransplant who are at high risk of infection or of wound healing complications. The most frequent reason for introducing everolimus in maintenance heart transplant patients is to support minimization or withdrawal of calcineurin inhibitor therapy, for example, due to impaired renal function or malignancy. Due to its potential to inhibit the progression of cardiac allograft vasculopathy and to reduce cytomegalovirus infection, everolimus should be initiated as soon as possible after heart transplantation. Immediate and adequate reduction of CNI exposure is mandatory from the start of everolimus therapy.