The Favorable impact of everolimus on Chronic lung allograft dysfunction in lung transplant recipients

Standard immunosuppressive therapy for lung transplant recipients combines a calcineurin inhibitor, an antimetabolite, and corticosteroids. In an observational, retrospective, monocentric study, we sought to compare the development of chronic lung allograft dysfunction (CLAD) between 37 patients who received this standard therapy (triple-therapy group) and 59 patients who received the mammalian target of rapamycin (mTOR) inhibitor everolimus in addition to the standard therapy (quadruple-therapy group). In the quadruple-therapy group, the time elapsed from transplantation to everolimus introduction (median [25th-75th percentile]) was 12 [7-25] months. In 46/59 cases, the indication for everolimus introduction was renal function sparing. Median follow-up durations were 36 [20-62] months and 84 [52-123] months in the triple-therapy and quadrupletherapy groups, respectively (p = 0.004). The incidence of CLAD was lower in patients receiving everolimus than in those who did not with an adjusted odds ratio of 0.303 [0.118-0.775]. In addition, the median time from transplantation to CLAD was longer in patients receiving quadruple therapy comprising everolimus than in those who did not (63 [30-92] vs. 29 [12-44] months; p = 0.025). This suggests that the addition of everolimus to a standard triple could result in a lower incidence of CLAD in lung transplant recipients.