Severe everolimus-associated pneumonitis in a renal transplant recipient

Area of Science:

• Nephrology and Transplant Immunology
• Pharmacology and Drug Safety

Background:

• Mammalian target of rapamycin (mTOR) inhibitors offer immunosuppression with reduced nephrotoxicity compared to calcineurin inhibitors.
• Their antiproliferative properties are beneficial in managing malignancy post-transplantation.
• First-generation mTOR inhibitors like sirolimus are associated with adverse events, including interstitial pneumonitis.

Observation:

• A kidney transplant recipient developed pneumonitis during treatment with everolimus, a second-generation mTOR inhibitor.
• This adverse event occurred despite the patient maintaining normal trough blood levels of everolimus.
• A previous report linked everolimus-induced pneumonitis to elevated drug levels in a heart transplant patient.

Findings:

• This case represents the first documented instance of everolimus-associated pneumonitis in a kidney transplant recipient with normal therapeutic drug concentrations.
• The pneumonitis fully resolved upon discontinuation of everolimus therapy.

Implications:

• Clinicians should consider everolimus-induced pneumonitis as a potential diagnosis in kidney transplant recipients, irrespective of trough blood levels.
• This finding highlights the importance of vigilant monitoring for respiratory adverse events in patients receiving mTOR inhibitors.
• Further research may be warranted to understand the mechanisms and risk factors for everolimus-associated pneumonitis.