Survival improvement with sirolimus plus tacrolimus immunosuppression for treatment of bronchiolitis obliterans syndrome after lung transplantation.

full dose CNI + antimetabolite, among patients retained on their assigned regimen, there was a nearly significant trend towards higher CLAD-free survival in the everolimus-treated group. 39 Additionally, a single-center retrospective study found better lung function in patients initiating sirolimus within 6 months post-transplant compared to patients initiating it later. 40 Finally, a small single-center study of very early sirolimus initiation (∼1 month post-transplant in patients with healed bronchial anastomoses) reported very low long-term BOS incidence. 41 Even in patients who already developed BOS, several small single-center studies suggest potential benefits of mTOR inhibitors.

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