Pulmonary Complications of Everolimus in Liver Transplant Patients: A 10-year Experience

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Conference Proceeding

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Publication Title

Am J Transplant


Purpose: The study aims to evaluate the safety of everolimus as part of the immunosuppression regimen in liver transplant patients. Methods: A retrospective study was conducted at a single, tertiary liver transplant center and was comprised of patients who had undergone liver transplant from 2009 to 2019. Patients were divided into two group depending on whether or not they had received everolimus during their post-transplant course. The primary outcome measured was the development of new pulmonary complications that have been associated with everolimus use. These complications include chronic obstructive pulmonary disease, pulmonary interstitial fibrosis, and pulmonary hypertension. The complications were measured by comparing pre- and post-transplant pulmonary function tests (PFTs) or by evaluating lung anatomy on computerized tomography (CT) scans. Secondary outcomes measured included everolimus discontinuation rates, re-transplant rates, and the rate of rejection between the two groups. Results: 450 patients were included in the study. 64% of the patients were male (n=288) and 83.6% of the patients were white. 65% (n=294) of the patients were never prescribed everolimus and 35% (n=156) of patients were prescribed everolimus throughout their transplant course. On average, patients were prescribed everolimus 208 days (range 35-2261 days) after transplant and the mean last known followup of the patients after everolimus initiation was 1529 days (2-2631). In regards to the primary outcome, 4% (n=6) of patients had a new pulmonary complication after everolimus initiation (n=6) and 6.3% of the control group patients had a new pulmonary complication (n=19). A chi-square statistic was used to calculate and the value was 1.33 with a p-value of 0.249. The result is not significant at p <.05. Of note, 51.3% (n=80) of the everolimus patients had to discontinue the medication throughout their use, with non-pulmonary adverse effects being the primary cause of discontinuation. The most common stand-alone causes of discontinuation were proteinuria, oral ulcers, and cost. 76.3% of the patients had multiple reasons for discontinuation. Secondary outcomes such as re-transplant rates and rejection rates had no significant difference between the everolimus and control group Conclusions: Everolimus appears to be safe from a pulmonary toxicity stand point, with no significant difference between patients who are taking everolimus and patients who are not. Furthermore, there was no significant difference in rejection and re-transplant rates. Of note, there was a significant amount of patients discontinuing the medication, primarily due to side effects. Larger multi-center studies would be needed to evaluate the side effects of everolimus and the tolerability of patients who had undergone liver transplant. CITATION INFORMATION: Obri M., Samad M., Alluri S., Alhaj Ali S., Almajed M., Ichkhanian Y., Jafri S. Pulmonary Complications of Everolimus in Liver Transplant Patients: A 10-year Experience AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: M.S.Obri: None. M.Samad: n/a. S.Alluri: n/a. S.Alhaj ali: n/a. M.R.Almajed: n/a. Y.Ichkhanian: n/a. S.Jafri: Speakers Bureau;; Gilead, Takeda, Abbvie.

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Not assigned.




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