(252) Sarcoidosis in Patients After Solid Organ Transplantation Treated with mTOR Inhibitors Versus Calcineurin Inhibitors

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 583

Presenting Author(s)

Emese K. Vágó
– Aarhus University, Aarhus N, Midtjylland, Denmark

Co-Author(s)

Matthew C. Baker
– Stanford University, United States
Suzanne Tamang
– Stanford University, United States
Henrik Toft Sørensen, MD, PhD, DMSc, DSc
– Professor & Chair, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark, Midtjylland, Denmark
Erzsebet Horvath-Puho
– Aarhus N, Midtjylland, Denmark

Background: Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. mTORC1 activation is associated with granuloma formation in mice and mTOR inhibitors have resolved granulomas in animal models. mTOR inhibitors may therefore prevent development of sarcoidosis.

Objectives: We hypothesized that the rate of incident sarcoidosis in patients after solid organ transplantation would be lower in patients treated with mTOR inhibitors compared with calcineurin inhibitor users.

Methods: We used the Danish National Patient Registry (DNPR) covering all Danish hospitals to identify patients with solid organ transplants between 1996-2018. Patients receiving mTOR inhibitor or calcineurin inhibitor treatment after the transplantation were included in the study. The DNPR and the Danish National Prescription Registry were used to identify treatment with mTOR inhibitors and calcineurin inhibitors. Patients with sarcoidosis outcome were identified from the DNPR based on the International Classification of Diseases-10 code D86.
Patients entered the cohort 90 days after the date of transplant and were followed until sarcoidosis diagnosis, date of death or 12.31.2018 —whichever came first. We calculated incidence rates of sarcoidosis and associated 95% confidence intervals (CIs).

Results: We identified 230 patients receiving mTOR inhibitor treatment for a total of 1068 person-years. The number of patients in the calcineurin inhibitor cohort was 3411 with 29495 person-years. The incidence rate of sarcoidosis was 0.34 (95% CI: 0.17, 0.60) per 1000 person-year in the calcineurin inhibitor cohort. There were no incident cases of sarcoidosis amongst patients receiving mTOR inhibitor treatment (95% CI for the rate per 1000 person-year: 0.00, 2.81).

Conclusions: Although our estimates were imprecise, we believe the results may provide support for future studies to explore the role of mTOR inhibitors in the treatment of sarcoidosis.