Effect of antifibrotic agents on postoperative complications after lung transplantation for idiopathic pulmonary fibrosis

Abstract

BackgroundAntifibrotic agents (AFAs) are now standard‐of‐care for idiopathic pulmonary fibrosis (IPF). Concerns have arisen about the safety of these drugs in patients undergoing lung transplantation (LTx).MethodsWe performed a multi‐centre, nationwide, retrospective, observational study of French IPF patients undergoing LTx between 2011 and 2018 to determine whether maintaining AFAs in the peri‐operative period leads to increased bronchial anastomoses issues, delay in skin healing and haemorrhagic complications. We compared the incidence of post‐operative complications and the survival of patients according to AFA exposure.ResultsAmong 205 patients who underwent LTx for IPF during the study period, 58 (28%) had received AFAs within 4 weeks before LTx (AFA group): pirfenidone in 37 (18.0%) and nintedanib in 21 (10.2%). The median duration of AFA treatment before LTx was 13.8 (5.6–24) months. The AFA and control groups did not significantly differ in airway, bleeding or skin healing complications (p = 0.91, p = 0.12 and p = 0.70, respectively). Primary graft dysfunction was less frequent in the AFA than control group (26% vs. 43%, p = 0.02), and the 90‐day mortality was lower (7% vs. 18%, p = 0.046).ConclusionsAFA therapy did not increase airway, bleeding or wound post‐operative complications after LTx and could be associated with reduced rates of primary graft dysfunction and 90‐day mortality.

Pre‐transplant anti‐fibrotics for idiopathic pulmonary fibrosis: Are we seeing a new role for the anti‐fibrotics?

“…Given the mechanism of action of the anti‐fibrotic treatments, their impact on perioperative LTx outcomes is also relevant as highlighted by the Moncomble et al in a recent publication in Respirology 10 . Published literature to date has reported no evidence for increased complications following the use of pre‐LTx anti‐fibrotic therapy 11–13 .…”

“…Published literature to date has reported no evidence for increased complications following the use of pre‐LTx anti‐fibrotic therapy 11–13 . Moncomble et al have further evaluated the safety of these medications in 58 patients with IPF undergoing LTx who received anti‐fibrotic treatment within 4 weeks of their LTx 10 . These patients did not have a higher risk of post‐operative complications specifically in the form of airway complication, including anastomosis dehiscence, fistulae and stenosis or haemorrhagic complications such as need for blood transfusion, surgery or embolization when compared with the control group.…”

“…A further possible benefit in IPF patients treated with pre‐LTx anti‐fibrotics has also been demonstrated in the form of shorter length of ICU stay and mechanical ventilation as well as a lower incidence of acute cellular rejection. Importantly, Moncomble et al were able to demonstrate via logistic regression modelling that anti‐fibrotic therapy was the only protective factor associated with 90‐day mortality 10 …”