AUTHOR=Infante Barbara , Troise Dario , Gravina Matteo , Minopoli Bruno , Gambacorta Marcella , Montanile Carmen , Macarini Luca , Mercuri Silvia , Cappiello Annalisa , Panico Maddalena , Ranieri Elena , Netti Giuseppe Stefano , Fortunato Francesca , Alfieri Carlo , Castellano Giuseppe , Stallone Giovanni 

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1562407

DOI=10.3389/fmed.2025.1562407

ISSN=2296-858X

ABSTRACT=IntroductionPatients 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.MethodsWe 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).ResultsThe 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.ConclusionOur findings are consistent with the observation that the use of mTORi could play a potentially beneficial role in improving pulmonary perfusion.