Everolimus is a potent immunosuppressive drug that is as effective as mycophenolate mofetil (MMF) or azathioprine (AZA) in preventing acute transplant rejection when used in combination with cyclosporin A (CyA). When everolimus is combined with full-dose CyA side effects are frequent and lead to high rates of drug discontinuation. A major finding was the occurrence of nephrotoxicity, which was probably caused by interactions with CyA. Therefore, continuous drug monitoring of everolimus and reducing CyA doses or introducing CyA-free regimens is highly recommended. Since everolimus inhibits proliferation, it may provide protection from chronic allograft damage, especially in heart and lung transplant patients, and may also have antitumor and antiviral effects. Studies to optimize the safe and effective use of everolimus are still ongoing. However, data from large multicenter trials in kidney and heart transplant patients have shown that everolimus could be an additional option for tailored immunosuppressive therapy for patients suffering from renal insufficiency, malignancies or chronic graft damage.
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