Impact of immunosuppressive therapy on pulmonary perfusion in kidney transplant recipients after COVID-19 illness

Introduction: Patients who have received kidney transplants (KTR) are considered to be more susceptible to the severity of COVID-19-related illness. The transplanted patient’s respiratory outcome worsened because of the ventilation-perfusion mismatch that occurs during the infection, which has been linked to endothelial damage. In this context, a reduction in immunosuppressive therapy is advisable to improve patient outcomes. However, the prognosis and suggested treatment for these types of patients are still debated. Methods: We retrospectively analyzed 48 KTRs with stable graft function on calcineurin inhibitor therapy who underwent transient modification of the maintenance immunosuppressive regimen with withdrawal of mycophenolic acid/mycophenolate mofetil or mTOR inhibitor (mTORi) during COVID-19 infection and their reintroduction after healing. Pulmonary functional tests (EGA and spirometry) and DECT (Dual-energy CT) scans were performed 1 month following the negative nasopharyngeal swab (T0) and then after 6 months (T6). Results: The presence an mTOR inhibitor in immunosuppressive therapy was associated with a significant increase in lung perfusion for the entire lung parenchyma of the mTORi-treated group, both in each lung segment considered separately and all of them together. Conclusion: Our findings are consistent with the observation that the use of mTORi could play a potentially beneficial role in improving pulmonary perfusion.