Long-term use of everolimus in lung transplant patients

Everolimus has been successfully used in solid organ transplantation, especially of the heart and kidney, but much less often in lung transplantation. The aim of this study was to evaluate the efficacy and safety of long-term use of everolimus in lung transplantation in Chile. We retrospectively analyzed patients receiving everolimus between 2005 and 2010 in terms of indication, lung and kidney function, rejection episodes, infections, malignancy appearance, and adverse events. Ten of 60 lung transplant recipients were converted to everolimus (16%) at some point after transplantation: four due to calcineurin inhibitor nephropathy (RD); four bronchiolitis obliterans syndrome (BOS); one lymphoma; and one, graft pulmonary fibrosis. Among patients with RD, at a mean follow-up of 25 months (range = 3-60), renal function remained stable with baseline of 42.7 mL/min and final creatinine clearance of 45.7 mL/min; lung function did not deteriorate. BOS patients, with an average of 30 months' follow-up (range = 12-48), showed baseline forced expiratory volume in the first second of 49% (r: 41-57) without variation in three patients, but with a decrease in another one after 12 months. One patient discontinued everolimus due to intolerance after 1 year. Two patients developed neoplasias: skin cancer and multiple myeloma. There were 14 infection episodes in seven patients, including 10 involving the respiratory tract infections. Only one patient developed dyslipidemia after everolimus initiation. Two patients died: one due to multiple myeloma and another to BOS. There was no rejection episode. Everolimus was effective and safe when used in combination with low doses of calcineurin inhibitor over long-term follow-up of lung transplant patients.