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

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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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

Original languageEnglish
JournalTherapeutic Advances in Respiratory Disease
Volume17
DOIs
StatePublished - Jan 1 2023

Keywords

  • interstitial lung disease
  • pulmonary fibrosis
  • surgery
  • tyrosine kinase
  • wound healing

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