ASSOCIATION BETWEEN EVEROLIMUS TIME-IN-THERAPEUTIC RANGE AND NEPHROTOXICITY IN ADULT LUNG TRANSPLANT RECIPIENTS
Author(s)
Brandon Michael McEwen, PharmD Candidate1, Mason Andrew Thompson, PharmD Candidate2.
1Student, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA, 2University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
1Student, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA, 2University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
OBJECTIVES: Everolimus is used in lung transplant recipients to reduce calcineurin inhibitor exposure while maintaining adequate immunosuppression. Due to its narrow therapeutic window, therapeutic drug monitoring is required. This study evaluates whether changes in everolimus time-in-therapeutic range (TTR) are associated with nephrotoxicity, measured by serum creatinine (SCr) changes, in adult lung transplant recipients.
METHODS: A retrospective cohort study was conducted at the UPMC Presbyterian Hospital Adult Lung Transplant Program. Adult lung transplant recipients receiving everolimus as part of their maintenance immunosuppressive regimen between January 1, 2011 and December 31, 2021 were included. TTR was calculated using the linear interpolation method over the year following everolimus initiation. Patients were stratified into quartiles based on the study population 25th, 50th, and 75th percentile TTR values. Nephrotoxicity was assessed using SCr percent difference from baseline to 1-year post-everolimus initiation and compared across TTR quartiles using a Kruskal-Wallis test.
RESULTS: A total of 368 patients were included in the analysis. The cohort was predominantly male (57.1%), white (90.8%), and bilateral lung transplant recipients (87.0%). Common transplant indications included idiopathic pulmonary fibrosis (28.0%), chronic obstructive pulmonary disease (25.0%), and cystic fibrosis (13.9%). The median SCr percent difference was +9% for the cohort overall, and +11%, +10%, +14%, and +8% for the 1st through 4th quartile groups, respectively. The Kruskal-Wallis test for SCr percent difference across groups yielded a p-value of 0.845.
CONCLUSIONS: No statistically significant differences in SCr percent change were observed across everolimus TTR quartiles, and the distribution of SCr percent difference was similar among all groups. These findings suggest that differences in everolimus TTR were not associated with nephrotoxicity in adult lung transplant recipients receiving everolimus-based immunosuppression, warranting further investigation of additional renal function markers and other long-term clinical outcomes.
METHODS: A retrospective cohort study was conducted at the UPMC Presbyterian Hospital Adult Lung Transplant Program. Adult lung transplant recipients receiving everolimus as part of their maintenance immunosuppressive regimen between January 1, 2011 and December 31, 2021 were included. TTR was calculated using the linear interpolation method over the year following everolimus initiation. Patients were stratified into quartiles based on the study population 25th, 50th, and 75th percentile TTR values. Nephrotoxicity was assessed using SCr percent difference from baseline to 1-year post-everolimus initiation and compared across TTR quartiles using a Kruskal-Wallis test.
RESULTS: A total of 368 patients were included in the analysis. The cohort was predominantly male (57.1%), white (90.8%), and bilateral lung transplant recipients (87.0%). Common transplant indications included idiopathic pulmonary fibrosis (28.0%), chronic obstructive pulmonary disease (25.0%), and cystic fibrosis (13.9%). The median SCr percent difference was +9% for the cohort overall, and +11%, +10%, +14%, and +8% for the 1st through 4th quartile groups, respectively. The Kruskal-Wallis test for SCr percent difference across groups yielded a p-value of 0.845.
CONCLUSIONS: No statistically significant differences in SCr percent change were observed across everolimus TTR quartiles, and the distribution of SCr percent difference was similar among all groups. These findings suggest that differences in everolimus TTR were not associated with nephrotoxicity in adult lung transplant recipients receiving everolimus-based immunosuppression, warranting further investigation of additional renal function markers and other long-term clinical outcomes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO222
Topic
Clinical Outcomes, Methodological & Statistical Research, Real World Data & Information Systems
Topic Subcategory
Clinical Outcomes Assessment, Relating Intermediate to Long-term Outcomes
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), Urinary/Kidney Disorders