Expanding Liver Transplant Immunosuppression Minimization Via Everolimus (CTOT-43)

Inability or unwillingness of a participant to give written informed consent or comply with study protocol

Active unresolved systemic viral, bacterial, fungal, or parasitic infection requiring oral or intravenous anti-infective therapy

History of autoimmune liver disease including autoimmune hepatitis, primary sclerosing cholangitis, and/or primary biliary cirrhosis, or other contraindications to drug withdrawal

History of non-hepatic autoimmune disease requiring current or future systemic immunosuppressive therapy other than per study protocol

History post-transplant of Hepatic Artery Thrombosis or Portal Vein Thrombosis

History of recurrent cirrhosis after liver transplantation

Chronic use of systemic glucocorticoids, biological immunomodulatory therapy, or other immunosuppressive agents other than per study protocol

History of hepatitis B or C virus infection with detectable viral PCR at enrollment

History of prior organ transplantation (liver or other type)

History of >= 2 biopsy-proven acute cellular rejection episodes of any severity, >=1 moderate to severe rejection episode (histologically defined or requiring lymphodepletion therapy), or >= 1 antibody- mediated rejection episode

Active treatment with any mTOR-inhibitor agent (everolimus, sirolimus)

Contraindication to treatment with everolimus (open wound or wound infection; urine protein: creatinine ratio > 0.5; significant pancytopenia (any of the following: WBC <1.5 K/uL or ANC <1000 cells/uL or actively being treated with GCSF; Hb <8.0; platelet count <50K); serum triglycerides > 1000 mg/dL; other per PI)

Abnormal liver function tests on study entry: Total Bilirubin (TB)>1.5 mg/dL and Direct Bilirubin (DB) >1.0 mg/dL, Alkaline Phosphatase (AP) >200 U/L, and Alanine Aminotransaminase (ALT)>60 U/L

Pregnant on enrollment or plan to become pregnant during the study period

Participation in another clinical trial that would interfere with this study's procedures and intervention:

1. Use of investigational biologic or drug (within 8 weeks of study enrollment)

2. Additional blood collection that would exceed research blood draw limits

3. Any other procedure or intervention, in the investigator's opinion would interfere with this study

Received live attenuated vaccine(s) within 2 months of enrollment

Current, diagnosed, mental illness or current, diagnosed, or self-reported drug or alcohol abuse that, in the opinion of the investigator, would interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study

Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study.