Purpose: Proliferation signal inhibitors(PSI) have a high discontinuation rate due to side effects. PSI induced pneumonitis has been reported in 14% in renal cell carcinoma and 0-7% in solid-organ transplants. We assessed incidence of pneumonitis in patients(pts) started on a PSI after heart transplantation(Htx) at our large single center.

Methods:Between 2007-15, 282 pts were started on a PSI post-HTx. 4 developed pneumonitis while on a PSI. They were compared 5:1 to a control group matched for age, sex, type of PSI, and time to PSI initiation. Endpoints: subsequent 1-yr survival, freedom from rejection, cardiac allograft vasculopathy (CAV) and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, coronary intervention, pacemaker implant, and stroke). We evaluated possible contributing risk factors (table).

Results:Pts were initiated on a PSI mean 1.9 yrs post-HTx. Incidence of pneumonitis after PSI initiation was 1.4% (n=4), 2 pts each on sirolimus and everolimus. Reasons for initiation: renal sparing, CMV, malignancy, and rejection. There was a significant difference in subsequent 1-yr survival. 3/4 pts developing pneumonitis died from infection and respiratory failure. 3/4 pneumonitis pts had pre-existing lung disease. No significant difference in subsequent 1-yr freedom from CAV, NF-MACE, and rejection.

Conclusion: The incidence of PSI induced pneumonitis after HTx is low but associated with high mortality. Pre-existing lung disease increases risk of pneumonitis post-PSI initiation.

CITATION INFORMATION: Levine R., Patel J., Levine M., Kittleson M., Kransdorf E., Dimbil S., Geft D., Chang D., Czer L., Kobashigawa J. Incidence of Pneumonitis in Heart Transplant Patients Started on a Proliferation Signal Inhibitor Am J Transplant. 2017;17 (suppl 3).

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