AUTHOR=Ivulich Steven , Paraskeva Miranda , Paul Eldho , Kirkpatrick Carl , Dooley Michael , Snell Gregory 

TITLE=Rescue Everolimus Post Lung Transplantation is Not Associated With an Increased Incidence of CLAD or CLAD-Related Mortality

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.10581

DOI=10.3389/ti.2023.10581

ISSN=1432-2277

ABSTRACT=Everolimus (EVE) has been used as a calcineurin inhibitor (CNI) minimization/ elimination agent or to augment immunosuppression in lung transplant recipients (LTR) with CNI-induced nephrotoxicity or neurotoxicity.  The long-term evidence of these immunosuppressive approaches on survival and progression to chronic lung allograft dysfunction (CLAD) is lacking. To compare LTR who switched to an EVE-based immunosuppressive regimen with those who remained on CNI-based regimens. The primary aim of the study were survival outcomes, with the secondary outcomes being time to CLAD, incidence of CLAD and the emergence of the obstructive (BOS) or restrictive (RAS) phenotypes. Single center retrospective study of 91 LTR who were matched 1:1 with those who remained on CNI-based immunosuppression. Survival and time to CLAD outcomes were calculated from the date of EVE commencement. On multivariate analysis, compared to those who remained on CNI-based immunosuppression, starting on EVE was not associated with poorer survival [HR 1.04, 95% CI: 0.67–1.61, p=0.853]. Compared to CNI-based immunosuppression starting on EVE-based immunosuppression was not associated with a statistically significant faster time to CLAD [HR 1.34, 95% CI: 0.87–2.04, p=0.182]. There was no difference in the emergence of CLAD (EVE, [n=57, 62.6%] vs CNI-based [n=52, 57.1%], p=0.41). There was no difference in the incidence of BOS (p=0.60) or RAS (p=0.16) between the EVE and the CNI groups. Introduction of EVE-based immunosuppression does not increase the risk of death or accelerate the progression to CLAD compared to those who remained on CNI-based immunosuppression.