Severe hypertriglyceridemia induced by everolimus in a lung transplant patient: Case report

INTRODUCTION: mTOR (mechanistic target of rapamycin) inhibitors (eg, everolimus) are increasingly used post-transplant to reduce calcineurin inhibitor nephrotoxicity but can cause severe dyslipidemia, including marked hypertriglyceridemia with pancreatitis risk. CASE PRESENTATION: A 64-year-old man with type 2 diabetes and chronic obstructive pulmonary disease, with resected pleomorphic giant-cell carcinoma, underwent left single-lung transplantation in March 2023. Everolimus was introduced on April 9, 2025, to spare calcineurin inhibitors in the setting of worsening renal function requiring dialysis. Triglycerides rose from 256 mg/dL (March 24, 2022) to 2886 mg/dL (August 5, 2025) and 4960 mg/dL (September 16, 2025). Everolimus was replaced by mycophenolate mofetil on September 26, 2025, with triglycerides (TGs) falling to 2000 mg/dL (September 29, 2025) and 300 mg/dL (November 3, 2025). INTERVENTIONS: Discontinuation of everolimus and switch to mycophenolate mofetil; continuation of pravastatin; and dietary measures. OUTCOMES: Rapid reduction in TGs after stopping everolimus; no acute pancreatitis documented in the available data. CONCLUSION: This case highlights everolimus-associated hypertriglyceridemia in a lung transplant recipient and underscores the need for tight lipid monitoring and early immunosuppression adjustment when severe dyslipidemia emerges.