Elsevier

Transplantation Proceedings

Volume 42, Issue 9, November 2010, Pages 3700-3703
Transplantation Proceedings

Thoracic transplantation
Heart
Common Occurrence of Everolimus-Associated Aphthous Stomatitis in Japanese Heart Transplant Recipients

https://doi.org/10.1016/j.transproceed.2010.06.023Get rights and content

Abstract

Mammalian target of rapamycin (mTOR) inhibitors display antiproliferative effects with less nephrotoxicity than calcineurin inhibitors. However, clinical use of mTOR inhibitors can be associated with a series of adverse events. We experienced cases of aphthous stomatitis associated with everolimus (EVL) in four Japanese heart transplant recipients treated at the target trough EVL blood level after a switch from mycophenolate mofetil between April and December 2007. All four patients developed aphthous stomatitis; three required reduction of the exposure and one, EVL discontinuation due to stomatitis as well as other side effects. All patients recovered from stomatitis after reduction or withdrawal of EVL. Thus, we considered that EVL-related stomatitis might occur commonly among the Japanese population. The proper dosage, effects, and frequency of the side effects of mTOR inhibitors may vary by ethnic population.

Section snippets

Case Reports

Clinical characteristics of the heart transplant recipients who were treated with the switch to EVL are shown in Table 1.

Discussion

Although the occurrence of EVL-associated aphthous stomatitis has not yet been described in the global literature, there have been several reports of sirolimus-associated aphthous stomatitis.10, 11, 12, 13 Ram et al reported a kidney transplant recipient who developed severe aphthous stomatitis after the administration of sirolimus whose disorder was cured by a switch to EVL.14

Aphthous stomatitis associated with sirolimus has been reported in 9% of psoriatic patients who received sirolimus.10

Acknowledgment

This work was supported by grants from Japan Cardiovascular Research Foundation and grants from the Japan Heart Foundation.

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