Everolimus Use in Lung Transplant Recipients |
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| Institution: | 1. Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey;2. Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey;1. Department of Pharmacy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan;2. Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan;3. Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan;4. Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan;5. Division of Urology, Department of Surgery, St. Martin De Porres Hospital, Chia-Yi City, Taiwan;1. Department of Pharmacy, Tokyo Women''s Medical University Hospital, Tokyo 162-8666, Japan;2. Department of Surgery, Kidney Center, Tokyo Women''s Medical University, Tokyo 162-8666, Japan;1. Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan;2. Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan;3. Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan;1. Department of Urology and Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan;2. Department of Urology, Tokyo Women''s Medical University, Tokyo, Japan;3. Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan;4. Department of Urology, Tokyo Women''s Medical University Yachiyo Medical Center, Chiba, Japan |
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| Abstract: | BackgroundMost lung transplantation centers prefer triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and corticosteroids. However, to prevent complications and comorbidities caused by tacrolimus, replacing the drug with everolimus has been considered.MethodsThis is a retrospective observational study investigating everolimus switch for different reasons. The population was divided into 3 groups: chronic lung allograft dysfunction (CLAD), kidney impairment, and malignant neoplasm groups. We investigated whether we achieved the goal of the switch and the frequency of rejection, cytomegalovirus and fungal infections, and everolimus adverse effects.ResultsNineteen patients received everolimus therapy, and 5 of these were for CLAD, 7 for tacrolimus nephrotoxicity, and 7 for explant/de novo malignant neoplasm. The patients were followed up for a mean (SD) of 30 (16.7) months under the therapy. The number of acute cellular rejection, cytomegalovirus infection, and aspergillosis infection cases before switch were 7, 13, and 2, respectively, and 7, 2, and 3 after that. The mean values of creatinine and estimated glomerular filtration rate of the whole population after the switch improved with no statistical significance, whereas it was significant in tacrolimus nephrotoxicity group. Three patients in the CLAD group remained stable after switching, whereas 2 progressed. Only 1 of the 7 patients with malignant neoplasms had a recurrence during 31.1 (16.5) months of median follow-up. Eleven cases of everolimus adverse effects occurred in 9 patients (47.3%), with 2 (10.5%) withdrawal events. Kidney impairment (P = .02) and age (P = .05) stood out as significant risk factors for drug adverse effects.ConclusionsAfter lung transplant, everolimus can be a safe alternative for immunosuppression with acceptable adverse effects. |
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