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Abstract
Introduction Antifibrotics slow progression of forced vital capacity (FVC) in patients with moderate Idiopathic Pulmonary Fibrosis (IPF) (FVC 50%–80%).1,2 Lung transplantation (LTx) is also a management option in a small cohort of patients who meet stringent eligibility criteria. With increased use of antifibrotics, questions remain about their safety in IPF patients undergoing LTx.
Methods All patients with multidisciplinary team (MDT) diagnosis of IPF that underwent lung transplantation from April 2013 to April 2017 were recruited from a single tertiary centre for ILD and lung transplantation. Retrospective data was obtained from medical notes. Statistical analysis was performed using chi squared test for categorical values and unpaired t-test.
Results 22 IPF patients (male 81.8%, female 18.2%) with mean age of 61.9 (+/-4.9) underwent single (n=16) and double (n=6) LTx. 15 (68%) received antifibrotics during the pre-transplantation period (pirfenidone n=14, nintedanib n=1) and 7 did not. Two patients actually had rheumatoid arthritis associated lung disease and were on immunosuppressant. Average waiting time for LTx was 7.0 months (+/-4.7 months). All patients on antifibrotics were on full dose, although 3 of them had a transient dose interruption at the start of their treatment with antifibrotics. Eight (36%) patients had complications post LTx, of which 4 died (antifibrotics, n=2) after the LTx due to multiple complications. 14 patients (64%) did not have complications at 3 months (antifibrotics n=10). There was no statistical significance between post-operative complication and age (p=0.6), gender (p=0.53) or antifibrotics use (p=0.67).
Conclusion Our data showed similar findings to a recent Belgian3 study that antifibrotics use prior to LTx does not impact on LTx outcomes or complications.
References
. Richeldi L, du Bois RM, Raghu G, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med2014;370(22):2071–82.
. King Jr TE, Bradford WZ, Castro-Bernardini S, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med2014;370(22):2083–92.
. Delanote I, Wuyts WA, Yserbyt J, et al. Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series. BMC Pulmonary Medicine2016;16:156.