SUCCESSFUL CALCINEURIN-INHIBITOR-FREE IMMUNOSUPPRESSION REGIMEN WITH SIROLIMUS AND PREDNISONE IN LUNG TRANSPLANT RECIPIENTS: A CASE SERIES

Abstract

SESSION TITLE: Fellows Transplantation Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: The current standard of care for immunosuppression after lung transplantation is the use of triple agents with a calcineurin inhibitor (CNI), cell cycle inhibitor (CCI), and corticosteroids (CS) with the calcineurin inhibitor (CNI) being the backbone of the regimen. However, the use of immunosuppressant drugs is frequently complicated by the development of malignancy, nephrotoxicity, cytopenias, and infection, usually requiring a reduction in immunosuppression. In cases where both CCIs and CNIs must be stopped, mTOR inhibitors are frequently used in an effort to maintain sufficient immunosuppression. A definitive role for mTOR inhibitors for immunosuppression post-lung transplant, however, remains unclear although there have been some studies in renal transplant recipients. There are challenges with transitioning to mTOR inhibitors due to concerns over wound healing in the first year, potential pulmonary toxicities, as well as the lack of data on efficacy. To our knowledge, there is no data on the outcomes of lung transplant patients maintained on dual immunosuppression with mTOR inhibitors and steroids alone. CASE PRESENTATION: We present a series of three lung transplant patients maintained on an immunosuppressant regimen of sirolimus and prednisone. All three patients remained free of acute cellular rejection and antibody-mediated rejection. Of the three patients, two remain alive and one patient died from multi-system organ failure secondary to sepsis. DISCUSSION: This small case series highlights the successful use of dual immunosuppression with mTOR inhibitors and corticosteroids in patients with contraindications to both calcineurin inhibitors and cell cycle inhibitors. CONCLUSIONS: More data is required to determine how mTOR-CS dual immunosuppression compares to traditional CCI-CNI-CS triple immunosuppression in regards to transplant rejection and the safest way to transition to this regimen when necessary. Reference #1: Ivulich S, Westall G, Dooley M, Snell G. The Evolution of Lung Transplant Immunosuppression. Drugs. 2018;78(10):965-982. doi:10.1007/s40265-018-0930-6 DISCLOSURES: No relevant relationships by Shambhu Aryal, source=Web Response No relevant relationships by Adam Cochrane, source=Web Response No relevant relationships by Margaret Fregoso, source=Web Response No relevant relationships by Vikramjit Khangoora, source=Web Response Consultant relationship with Veracyte Please note: $1001 - $5000 Added 04/03/2020 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with United Therapeutics Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Roche-Genentech Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Honoraria