High‐dose calcineurin inhibitor‐free everolimus as a maintenance regimen for heart transplantation may be a risk factor for P neumocystis pneumonia

Background Everolimus reduces the incidence of cardiac‐allograft vasculopathy ( CAV ) and is less renally toxic than are calcineurin inhibitors ( CNI s). We evaluated the safety of CNI ‐free everolimus for post‐heart transplant ( HT x) patients. Methods We retrospectively reviewed the records of 36 consecutive patients who had undergone an HT x between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group—12 patients with CAV , renal impairment, or a history of malignancy—were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8‐14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia ( PJP ); and rejection (≥2R). Results During a 53.3±25.6‐month follow‐up, the survival rate, rejection rate, and number of infections, except for PJP , were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow‐up. Conclusions A high‐dose CNI ‐free everolimus maintenance regimen might yield a higher incidence of post‐transplantation PJP .