The role of everolimus in cardiac transplantation is being increasingly recognized.Multiple studies have been published comparing the use of everolimus and mycophenolate with varying results. We aimed to perform a meta-analysis of the published literature.
We searched Pubmed, EBSCO and Cochrane databases for terms “everolimus”, “mycophenolate”, “heart transplantation”, “cardiac transplantation” and their combinations. All studies in which everolimus was compared to mycophenolate were included. Studies in language other than English were excluded.
Rates of biopsy proven acute rejection (OR 0.82 CI 0.67 to 1.00, p = 0.05), hemodynamically significant rejection (OR 0.76, CI 0.39 to 1.50, p = 0.43)or change in glomerular filtration rate (GFR) (mean difference -1.91, CI -6.90 to 3.08, p = 0.45) were similar between everolimus and mycophenolate groups. Everolimus use was associated with significant reduction in average maximal intimal thickness (mean difference -0.04 CI -0.06 to -0.02, p = 0.001) and cytomegalovirus antigenemia (OR 0.38, CI 0.28 to 0.53, p < 0.00001). There was no significant heterogeneity for any endpoint except change in GFR.
As compared to mycophenolate, everolimus use is associated with similar antirejection outcomes after cardiac transplantation but with reduced maximal intimal thickness and cytomegalovirus antigenemia.
Speckle-tracking 2-dimensional strain echocardiography: A new noninvasive imaging tool to evaluate acute rejection in cardiac transplantation
