Everolimus and Low-Dose Tacrolimus After Heart Transplant in Children

Is everolimus combined with low-dose tacrolimus safe and effective for preventing rejection in children when initiated 6 months after heart transplant?In this multicenter trial that randomized 211 children at 6 months after heart transplant, everolimus and low-dose tacrolimus did not differ from tacrolimus and mycophenolate in preventing the composite end point of cellular rejection, cardiac allograft vasculopathy, and chronic kidney disease. However, everolimus and low-dose tacrolimus appeared to be safe based on the total burden of 6 major transplant events at 30 months and may be associated with improved kidney function and less cytomegalovirus infection.While everolimus combined with low-dose tacrolimus was not associated with superior efficacy in preventing rejection, cardiac allograft vasculopathy, and chronic kidney disease, the regimen appeared to be safe based on the total burden of transplant complications at 30 months. Everolimus and low-dose tacrolimus may be a suitable alternative to tacrolimus and mycophenolate in pediatric heart transplant recipients.

Corresponding Author: Christopher S. Almond, MD, MPH, Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Ste 325, Palo Alto, CA 94304 (calmond@stanford.edu).

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