Safety of Everolimus in Lung Transplant Recipients Undergoing Surveillance Bronchoscopy with Transbronchial Forceps Biopsy and Cryobiopsy: A Retrospective Cohort Study.

Objectives: Managing posttransplant immunosuppression in lung transplant recipients is crucial yet complex. Everolimus, a mechanistic target of rapamycin inhibitor, offers benefits such as reduced chronic rejection and improved management of donor-specific antibodies. However, its potential to impair wound healing raises concerns, particularly with minimally invasive procedures like surveillance bronchoscopy with cryobiopsy. We evaluated whether everolimus use in lung transplant recipients increases the risk of complications, particularly bleeding, during bronchoscopy.

Materials and methods: Our retrospective cohort study analyzed data from lung transplant recipients at the University Hospital Zurich (2022-2023). We categorized patients based on immunosuppressive regimen: patients on everolimus and patients on standard calcineurin inhibitor-based regimens. We reviewed outcomes from 105 bronchoscopies, involving both forceps biopsies and cryobiopsies. For primary outcomes, we examined bleeding incidence, with severity graded with the Nashville Bleeding Scale. We conducted statistical analyses by using the X² test, with significance set at P < .05.

Results: We examined 41 bronchoscopies in patients on everolimus and 64 bronchoscopies in patients who were not treated with everolimus. No significant difference in bleeding incidence was shown between groups (P > .05). No bleeding occurred in 68.3% of patients with everolimus and 60.9% of patients without everolimus. Grade 2 bleeding occurred in 26.8% of patients with everolimus and in 34.4% of patients without everolimus, with no significance difference. No grade 4 bleeding or life-threatening complications were recorded, and a minor pneumothorax was observed in only 1 patient in the group without everolimus.

Conclusions: Everolimus use in lung transplant recipients did not increase the risk of bleeding or other complications during surveillance bronchoscopy with forceps and cryobiopsies. We suggest that everolimus therapy can be safely continued during such procedures, supporting its uninterrupted application in lung transplant patients.