The use of mTOR inhibitors is associated with improved survival in lung transplant recipients

Background: Malignancy after lung transplantation is an important cause of morbidity and mortality and is associated with the intensity and cumulative dose of immunosuppressive drugs. There is some evidence that the use of mammalian target of rapamycin (mTOR) inhibitors may reduce the risk of malignancy in kidney transplant recipients. Aims: To compare the effect of everolimus on the incidence of new malignancies, as well as the rate of acute rejection, CMV infection and overall survival between lung transplant recipients who were treated with an everolimus/calcineurin inhibitors (CNI)-based regimen versus CNI-based regimen. Methods: A single center retrospective cohort study including all transplanted patients treated with everolimus for >7 months from 1998-2019. Propensity score matching was used to select a similar control group. Results: 142 lung transplant recipients and matched controls were included. The incidence of malignancies was not significantly different between groups (RR 0.75, CI 0.34-1.67, P=0.48). However, a survival benefit was demonstrated in the everolimus group compared to the control group. In addition, the rate of acute rejection events was lower in the everolimus group (RR 0.31, CI 0.15-0.63, P=0.001). There were also less CMV infection episodes in the everolimus group (8.4%) compared to the control group (16.9%) (P=0.07). Conclusions: Whereas our study did not show a significant difference in the incidence of malignancies among the two groups of lung transplant recipients, our results suggest that treatment with everolimus may prolong survival and decrease the rates of acute rejection and CMV infection episodes.