Case reportEverolimus-related Pulmonary Toxicity in Heart Transplant Recipients
Section snippets
Case 1
A 45-year-old man with end-stage cardiomyopathy underwent HTx in 1989. Inmunosuppression was based on cyclosporine (CyA), azathioprine and prednisone until 1996, when corticosteroids were withdrawn. Despite a progressive reduction of CyA dosing (reaching levels of <100 ng/ml) creatinine clearance continuously decreased. In September 2006, CyA was replaced by everolimus due to progressive renal dysfunction (creatinine: 2.5 mg/dl; estimated clearance by Cockroft–Gault formula: 34 ml/min). At that
Case 2
A 66-year-old man underwent his first HTx procedure at age 45. He was retransplanted 9 years later due to allograft vascular disease. His maintenance inmunosuppression consisted of CyA and azathioprine. In December 2006 he was switched to everolimus because of progressive renal dysfunction (creatinine: 2.3 mg/dl; clearance by Cockroft–Gault formula: 35 ml/min) despite of low levels of CyA (<100 ng/ml). During the first 2 months, everolimus was well tolerated and serum levels were stable (range
Discussion
Sirolimus and everolimus belong to a new class of immunosuppressants known as PSIs. Because of their potential benefits in patients with renal dysfunction, graft vascular disease and malignancies, they are being used increasingly in solid-organ transplantation.1 For our patients, we chose conversion to everolimus to avoid the progression of chronic renal dysfunction. Although this indication is not yet clearly established, positive experience is accumulating in this setting.2, 3 Unfortunately,
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Cited by (50)
Life-Threatening Everolimus-Associated Pneumonitis: A Case Report and a Review of the Literature
2018, Transplantation ProceedingsNoninfectious Pulmonary Complications of Liver, Heart, and Kidney Transplantation: An Update
2017, Clinics in Chest MedicineCitation Excerpt :Withdrawal of sirolimus may be sufficient to treat pneumonitis, but corticosteroids are often administered to hasten resolution. Interstitial pneumonitis and diffuse alveolar hemorrhage also have been reported in solid organ transplant recipients receiving everolimus.55,56 In one study of 409 renal transplant recipients receiving an mTOR inhibitor as part of maintenance immunosuppression, the incidence of pneumonitis was 4.8% among those receiving sirolimus and 6.8% among those receiving everolimus, suggesting that pulmonary toxicity is likely to be a class effect.57
Everolimus-Induced Systemic Serositis After Simultaneous Liver and Kidney Transplantation: A Case Report
2017, Transplantation ProceedingsInterstitial Lung Disease after Kidney Transplantation and the Role of Everolimus
2016, Transplantation ProceedingsEverolimus associated interstitial pneumonitis in a liver transplant patient
2016, Respiratory Medicine Case ReportsCitation Excerpt :Everolimus is used as an immunosuppressant in solid organ transplant patients [1]. Interstitial pneumonitis is associated with everolimus and has been reported in literature with similar presentation as described in our case [2–11]. The exact pathogenesis of the lung toxicity cause by mTOR inhibitors is not clear.
Pulmonary Complications of Stem Cell and Solid Organ Transplantation
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition