Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy

Leuschner, Gabriela; Stocker, Florian; Veit, Tobias; Kneidinger, Nikolaus; Winter, Hauke; Schramm, René; Weig, Thomas; Matthes, Sandhya; Ceelen, Felix; Arnold, P; Munker, Dieter; Klenner, Friederike; Hatz, Rudolf; Frankenberger, Marion; Behr, Jürgen; Neurohr, Claus

doi:10.1016/j.healun.2017.07.002

Cited by 48 publications

(65 citation statements)

References 21 publications

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“…This single‐centre study showed no increased risk of either bleeding or wound healing in patients treated with antifibrotic therapy compared with untreated IPF patients. Furthermore, postoperative outcomes were observed with equal frequency between treated and untreated IPF patients . Differently with previous studies, here, we report the experience of three major transplant centres in Italy focusing on the newer antifibrotic therapy, nintedanib, to allow for more precise observations, which are strictly related to one type of drug.…”

Section: Discussionmentioning

confidence: 99%

“…Until now, data on the use of antifibrotic therapy in patients undergoing lung transplantation were limited, particularly for nintedanib, which was only used by two of nine patients in a recent case series describing preoperative course and post-transplant outcomes in IPF patients [16]. Leuschner et al recently reported the outcomes after transplant of 30 IPF patients treated with antifibrotic therapy (7 of 30 patients were treated with nintedanib) compared with 32 untreated IPF patients [17]. This single-centre study showed no increased risk of either bleeding or wound healing in patients treated with antifibrotic therapy compared with untreated IPF patients.…”

Section: Discussionmentioning

confidence: 99%

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Safety of nintedanib before lung transplant: an Italian case series

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Solidoro

Parigi

et al. 2018

Respirology Case Reports

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Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disease that can only be cured by lung transplantation. Pharmacological agents play a role in preserving lung function and prolonging survival until a suitable donor organ becomes available. However, data on the effects of newer antifibrotic therapies on lung transplantation outcomes in IPF patients are lacking. The nine patients included in this case series were treated with nintedanib 150 mg twice daily for 3–30 (mean 13 ± 9) months before lung transplant surgery. Lung function was relatively preserved during nintedanib therapy, and no acute IPF exacerbations occurred. Transplant surgery was generally uneventful; eight of the nine patients are still alive. There were no extraordinary bleeding complications or issues with postoperative thoracic wound healing or dehiscence. Only one patient experienced bronchial anastomotic stenosis a few months later. In conclusion, nintedanib preserved lung function up to transplantation, was well tolerated, and had no detrimental effects on the short‐term outcome of lung transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety of nintedanib before lung transplant: an Italian case series

Balestro

Solidoro

Parigi

et al. 2018

Respirology Case Reports

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“…A second retrospective study in Italy (nintedanib, n = 9), inclusive of data from 3 different transplant centers, also reported no problems with postoperative bleeding or thoracic wound healing [46]. Finally, in a recent German study (nintedanib, n = 7), it was concluded that exposure to anti-fibrotic treatment prior to lung transplantation did not increase surgical complications, wound healing complications, anastomotic complications, or postoperative mortality [47]. …”

Section: Expert Statements and Recommendationsmentioning

confidence: 99%

Nintedanib in Idiopathic Pulmonary Fibrosis: Practical Management Recommendations for Potential Adverse Events

et al. 2018

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Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with a dismal survival rate of only 3 years and no curative pharmacological therapy. The recent approval of 2 anti-fibrotic drugs (nintedanib and pirfenidone) that slow disease progression has provided some hope for patients. However, effectively managing anti-fibrotic treatment can be a challenge due to tolerability issues, the presence of pulmonary and extra-pulmonary comorbidities, and the need for concomitant medications in many patients. In general, making clear evidence-based decisions can be difficult for physicians because patients with comorbidities are often excluded from clinical trials. Since currently anti-fibrotic drugs are the only effective therapeutics capable of slowing disease progression, it is imperative that all treatment options are thoroughly evaluated and exhausted in each individual, irrespective of complicating factors, to permit the best outcome for the patient. In this review, we present data from clinical trials, post hoc analyses, post-marketing surveillance, and real-world studies that are relevant to the management of nintedanib treatment. In addition, we also provide practical recommendations developed by a multidisciplinary panel of experts for the management of nintedanib treatment in patients with IPF associated complications and those experiencing gastrointestinal side effects.

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“…Leuschner et al . reported that in 30 IPF LTx patients on previous treatment with antifibrotics, there was no increase in blood product utilization, wound healing or anastomotic complications after LTx. A recent large volume study looked at ILD patients treated with either glucocorticoids ( n = 72; n = 46 patients with IPF), pirfenidone ( n = 23) or nintedanib ( n = 13) prior to LTx and corroborated this data by stating that the use of antifibrotics alone or in addition to corticosteroids in SSLTx patients was safe, even when administered within the last four weeks before surgery .…”

Section: Discussionmentioning

confidence: 97%

Determinants of survival in lung transplantation patients with idiopathic pulmonary fibrosis: a retrospective cohort study

et al. 2018

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Summary Survival after lung transplantation (LTx) for idiopathic pulmonary fibrosis (IPF) is worse compared to other indications for LTx. We investigated the effect of several pretransplant variables including the use of pretransplant corticosteroids (CS) on post‐transplant graft and chronic lung allograft dysfunction (CLAD)‐free survival and functional testing (maximum inspiratory and expiratory pressure, six‐minute walk test, quadriceps and hand pinch force) in a small cohort of IPF patients. We retrospectively compared two groups of IPF patients (n = 36 on CS vs. n = 18 not on CS) who underwent LTx between 2000 and 2016. Analysis of 54 IPF‐LTx patients showed no significant effect on graft survival or functional tests except for maximum inspiratory pressure (P = 0.033) between these two groups (all LTx patients, CS vs. no CS). Regression analysis showed significant impact of procedure with a hazard ratio of 0.423 (CI 95% 0.194, 0.924) favoring sequential single LTx (SSLTx) compared to single lung transplantation (SLTx). When analyzing only the 40 SSLTx patients, corticosteroid‐free patients showed significantly better graft survival compared to patients on CS (P = 0.045) and CLAD‐free survival (P = 0.019). The possible detrimental effect of corticosteroid therapy before LTx was demonstrated in this cohort of SSLTx patients, which questions the use of corticosteroids in a pretransplantation setting.

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Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy

Cited by 48 publications

References 21 publications

Safety of nintedanib before lung transplant: an Italian case series

Safety of nintedanib before lung transplant: an Italian case series

Nintedanib in Idiopathic Pulmonary Fibrosis: Practical Management Recommendations for Potential Adverse Events

Determinants of survival in lung transplantation patients with idiopathic pulmonary fibrosis: a retrospective cohort study

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