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Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy
Abstract
Background Anti-fibrotic drugs may interfere with wound-healing after major surgery, theoretically preventing sufficient bronchial anastomosis formation after lung transplantation (LTx). The aim of this study was to assess the impact of previous treatment with pirfenidone and nintedanib on outcomes after LTx in patients with idiopathic pulmonary fibrosis (IPF). Methods All patients with IPF undergoing LTx at the University of Munich between January 2012 and November 2016 were retrospectively screened for previous use of anti-fibrotics. Post-transplant outcome and survival of patients with and without anti-fibrotic treatment were analyzed. Results A total of 62 patients with IPF were transplanted (lung allocation score [mean ± SD] 53.1 ± 16.1). Of these, 23 (37.1%) received pirfenidone and 7 (11.3%) received nintedanib before LTx; the remaining 32 (51.6%) did not receive any anti-fibrotic drug (control group). Patients receiving anti-fibrotics were significantly older (p = 0.004) and their carbon monoxide diffusion capacity was significantly higher (p = 0.008) than in controls. Previous anti-fibrotic treatment did not increase blood product utilization, wound-healing or anastomotic complications after LTx. Post-transplant surgical revisions due to bleeding and/or impaired wound-healing were necessary in 18 (29.0%) patients (pirfenidone 30.4%, nintedanib 14.3%, control 31.3%; p = 0.66). Anastomosis insufficiency occurred in 2 (3.2%) patients, both in the control group. No patie…
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Recent case series found no impaired wound or anastomotic healing and no increased bleeding risk in interstitial lung disease patients taking nintedanib or pirfenidone.
“Although mechanistically anti-fibrotic medications could affect wound healing, recent case series have shown no impaired wound or anastomotic healing and no increase in bleeding risk in patients on these medications.(240, 241)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [241]
Citations
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Cited by
Sorted by citations
Leard, L. E., Holm, A. M., Valapour, M., Glanville, A. R., Attawar, S., Aversa, M., Campos, S. V., Christon, L. M., Cypel, M., Dellgren, G., et al. (2021) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2021.07.005 · Cited by 821
Survival in adult lung transplantation: where are we in 2020?
Bos, S., Vos, R., Van Raemdonck, D. E., & Verleden, G. M. (2020) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000753 · Cited by 281
Anti-fibrotic therapy and lung transplant outcomes in patients with idiopathic pulmonary fibrosis
Astor, T. L., Goldberg, H. J., Snyder, L. D., Courtwright, A., Hachem, R., Pena, T., Zaffiri, L., Criner, G. J., Budev, M. M., Thaniyavarn, T., et al. (2023) · Therapeutic Advances in Respiratory Disease · doi:10.1177/17534666231165912 · Cited by 8
Metadata
- Authors
- Leuschner, G., Stocker, F., Veit, T., Kneidinger, N., Winter, H., Schramm, R., Weig, T., Matthes, S., Ceelen, F., Arnold, P., Munker, D., Klenner, F., Hatz, R., Frankenberger, M., Behr, J., & Neurohr, C.
- Affiliations
- German Center for Lung Research (DE)
- Ludwig-Maximilians-Universität München (DE)
- Helmholtz Munich (DE)
- Corresponding author
- Leuschner, Gabriela
- ORCID
- Venue
- The Journal of Heart and Lung Transplantation
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 37
- Issue
- 2
- Pages
- 268-274
- ISSN
- 1053-2498 (ISSN-L)
- OpenAlex
- W2733752510
- Cited by
- 59
- References
- 6
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 10 · 2022: 4 · 2021: 11 · 2020: 6 · 2019: 12 · 2018: 11
- FWCI
- 8.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Heart and Lung Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Site cant be reached (submittedVersion)
- PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Keywords
- lung transplantation, idiopathic pulmonary fibrosis, antifibrotic therapy, pirfenidone, nintedanib, bronchial anastomosis, wound healing, anastomotic complications, post-transplant survival, surgical revision
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