Anti-fibrotic therapy and lung transplant outcomes in patients with idiopathic pulmonary fibrosis.

Abstract

BACKGROUND:

It is unclear whether continuing anti-fibrotic therapy until the time of lung transplant increases the risk of complications in patients with idiopathic pulmonary fibrosis.

OBJECTIVES:

To investigate whether the time between discontinuation of anti-fibrotic therapy and lung transplant in patients with idiopathic pulmonary fibrosis affects the risk of complications.

METHODS:

We assessed intra-operative and post-transplant complications among patients with idiopathic pulmonary fibrosis who underwent lung transplant and had been treated with nintedanib or pirfenidone continuously for ⩾ 90 days at listing. Patients were grouped according to whether they had a shorter (⩽ 5 medication half-lives) or longer (> 5 medication half-lives) time between discontinuation of anti-fibrotic medication and transplant. Five half-lives corresponded to 2 days for nintedanib and 1 day for pirfenidone.

RESULTS:

Among patients taking nintedanib (n = 107) or pirfenidone (n = 190), 211 (71.0%) had discontinued anti-fibrotic therapy ⩽ 5 medication half-lives before transplant. Anastomotic and sternal dehiscence occurred only in this group (anastomotic: 11 patients [5.2%], p = 0.031 vs patients with longer time between discontinuation of anti-fibrotic medication and transplant; sternal: 12 patients [5.7%], p = 0.024). No differences were observed in surgical wound dehiscence, length of hospital stay, or survival to discharge between groups with a shorter versus longer time between discontinuation of anti-fibrotic therapy and transplant.

CONCLUSION:

Anastomotic and sternal dehiscence only occurred in patients with idiopathic pulmonary fibrosis who discontinued anti-fibrotic therapy < 5 medication half-lives before transplant. The frequency of other intra-operative and post-transplant complications did not appear to differ depending on when anti-fibrotic therapy was discontinued.

REGISTRATION:

clinicaltrials.gov NCT04316780: https://clinicaltrials.gov/ct2/show/NCT04316780.

• Authors: Todd L Astor, Hilary J Goldberg, Laurie D Snyder, Andrew Courtwright, Ramsey Hachem, Tahuanty Pena, Lorenzo Zaffiri, Gerard J Criner, Marie M Budev, Tany Thaniyavarn, Thomas B Leonard, Shaun Bender, Aliaa Barakat, Janis L Breeze, Peter LaCamera
• Journal: Therapeutic advances in respiratory disease (Ther Adv Respir Dis) 2023 Jan-Dec Vol. 17 Pg. 17534666231165912 ISSN: 1753-4666 [Electronic] England
• PMID: 37073794 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Humans
• Fibrosis
• Idiopathic Pulmonary Fibrosis (diagnosis, drug therapy, surgery)
• Lung Transplantation (adverse effects)
• Treatment Outcome