Antifibrotics and lung transplantation: A Spanish multicentre case-controlled study

Autores de IIS La Fe

• Gabriel Victorino Anguera De Francisco

  Autor

• Juan Pablo Reig Mezquida

  Autor

• Amparo Solé Jover

  Autor

Participantes ajenos a IIS La Fe

• Mora Cuesta, Victor Manuel
• Iturbe Fernandez, David
• Aguado Ibanez, Silvia
• Margallo Iribarnegaray, Juan
• Carrillo Hernandez-Rubio, Javier
• Perez Luz, Virginia
• Laporta Hernandez, Rosalia
• de Pablo Gafas, Alicia
• Cifrian Martinez, Jose Manuel

Grupos

• Infección Grave

Abstract

Background and objective Antifibrotic drugs are the standard treatments for patients with idiopathic pulmonary fibrosis (IPF). This study aims to assess the safety of antifibrotic treatment in IPF patients undergoing lung transplantation. Methods Patients with a diagnosis of IPF who received a lung transplant between January 2015 and June 2019 at four Spanish hospitals specialized in lung transplantation were retrospectively recruited. Cases were defined as patients receiving antifibrotic treatments at time of transplant. Each case was matched with a control who did not receive antifibrotic treatment. Results A total of 164 patients were included in the study cohort (103 cases and 61 controls). There were no statistically significant differences between the cases and controls in any of the items studied related to transplantation except the time until the appearance of chest wall dehiscence: although there were no differences in the incidence of wall dehiscence in either group (12.3% vs. 13.7%; p = 0.318), the patients on antifibrotic drugs experienced it earlier (21 days [IQR = 12.5-41.5] vs. 63 days [IQR = 46.75-152.25]; p = 0.012). There were no differences in overall post-transplant survival between the two groups (p = 0.698) or in conditional survival at 30 days, 90 days, 3 years or 5 years. However, 1 year survival was significantly greater among controls (80.6% vs. 93.3%; p = 0.028). Conclusion There was evidence that chest wall dehiscences appeared earlier post-transplant in patients using antifibrotics, even though this factor did not significantly impact survival.

© 2022 Asian Pacific Society of Respirology.

Keywords

• antifibrotic treatment; idiopathic pulmonary fibrosis; lung transplantation; nintendanib; pirfenidone