Safety And Efficacy Of Everolimus In De Novo Liver Transplant Recipients:a Systerm Review

BACKGROUNDEverolimus is an inhibitor of the mammalian target of rapamycin, mainlytarget in cell signal transduction pathway of serine/threonine protein kinase,cell cycle arrest in G1phase and S phase, this pathway is also IL-2Rsignaling pathways of downstream. It is proved efficacy on a large numberof clinical studies on the breast, pancreas, kidney and neuroendocrinetumors. Because of its preventing fibrosis,it has been widely used in elutingstent in the treatment of cardiovascular intervention. In the aspect ofimmune inhibition, it has been used for immunosuppressive therapy inkidney posttransplant and heart posttransplant,in order to reduce orcompletely replace calcineurin inhibitors, such as cyclosporin ortacrolimus,etc. On February15th,2013, Novartis announced that the USFood and Drug Administration (FDA) has approved Zortress (everolimus)for the prophylaxis of organ rejection in adult liver transplant recipients.Zortress is an immunosuppressant.The FDA has previously approvedZortress for use in kidney transplant recipients.Now there have been manyreports on clinical application in the treatment of everolimus onimmunosuppression after liver transplantation in the first,but the largecontent of the sample,prospective,multicenter,randomized controlled trials are currently less.OBJECTIVESSystem review of safety and efficacy of everolimus in post-de novo livertransplantation.SEARCH METHODSDetermine the search strategy with relevant knowledge of Cockranehand book5.2, Search for Pubmed, Embase, Cochrane library, CNKI, VIP,CEBM/CCD, and conference papers were retrieved.Manual search ofrelevant journals.Evaluate the included RCT and extraction the results.Theresults were analyzed with Revman5.2software, drawing a preliminaryconclusion.RESULTSThrough the initial inspection and through the retest,eventually fourRCTs are encluded.After12months of follow-up,EVR group verses CNI(CsA or TAC)group,BPAR events decreased,the difference was statisticallysignificance.For mortality and graft loss,the study of homogeneity is better(P>0.1),but between two groups have no significant differences.Toremoval of a significant heterogeneity study,on renal functi onprotection,EVR group is better than the CNI group,the differences havestatistical significances.CONCLUSIONSThe application of EVR after de novo transplantation of liver, canreduse doses of CNI or completely replace and can not increase mortalityand graft loss at the same time. Due to the few existing randomizedcontrolled trial.More samples content,prospective,multicenter, randomizedcontrolled double-blind trial to support are needed.