Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
Int Immunopharmacol. 2021 May;94:107501. doi: 10.1016/j.intimp.2021.107501. Epub 2021 Feb 26.
Mammalian target of rapamycin inhibitors (mTORi) are increasingly used after lung transplantation as part of a calcineurin inhibitor sparing regimen, aiming to preserve renal function. The aim of our study was to determine whether immunosuppressive therapy using mTORi in lung transplant recipients (LTR) is feasible in practice, or limited by intolerance and adverse events. Data were retrospectively assessed for all LTR transplanted between July 1991 and January 2020. Patients ever receiving mTORi (monotherapy or in combination with calcineurin inhibitor) as treatment of physicians' choice were included. 149/1184 (13%) of the LTR ever received mTORi. Main reasons to start were renal insufficiency (67%) and malignancy (21%). In 52% of the patients, mTORi was stopped due to side effects or drug toxicity after a median time of 159 days. Apart from death, main reasons for discontinuation were infection (19%) and edema (14%). Early discontinuation (<90 days) was mainly due to edema or gastrointestinal intolerance. As mTORi was stopped due to adverse events or drug intolerance in 52% of LTR, cautious consideration of advantages and disadvantages when starting mTORi is recommended.
哺乳动物雷帕霉素靶蛋白抑制剂（mTORi）在肺移植后越来越多地被用作钙调磷酸酶抑制剂节省方案的一部分，旨在保护肾功能。我们的研究目的是确定在肺移植受者（LTR）中使用 mTORi 的免疫抑制治疗在实践中是否可行，或者是否受到不耐受和不良事件的限制。回顾性评估了 1991 年 7 月至 2020 年 1 月期间所有接受肺移植的 LTR 的数据。纳入了根据医生选择接受 mTORi（单药治疗或与钙调磷酸酶抑制剂联合治疗）治疗的患者。149/1184（13%）的 LTR 曾接受 mTORi 治疗。开始治疗的主要原因是肾功能不全（67%）和恶性肿瘤（21%）。由于副作用或药物毒性，mTORi 在中位时间 159 天后在 52%的患者中停止使用。除死亡外，停药的主要原因是感染（19%）和水肿（14%）。早期停药（<90 天）主要是由于水肿或胃肠道不耐受。由于 52%的 LTR 因不良事件或药物不耐受而停止使用 mTORi，因此建议在开始使用 mTORi 时谨慎考虑其优缺点。
