Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series

BMC Pulm Med. 2016 Nov 18;16(1):156. doi: 10.1186/s12890-016-0308-z.

Abstract

Background: Following recent approval of pirfenidone and nintedanib for idiopathic pulmonary fibrosis (IPF), questions arise about the use of these antifibrotics in patients awaiting lung transplantation (LTx).

Methods: Safety and efficacy of antifibrotic drugs in IPF patients undergoing LTx were investigated in a single-centre retrospective cohort analysis.

Results: A total of nine patients, receiving antifibrotic therapy for 419 ± 315 days until subsequent LTx, were included. No major side effects were noted. Significant weight loss occurred during antifibrotic treatment (p = 0.0062). FVC tended to stabilize after 12 weeks of treatment in most patients. A moderate decline in FVC, TLC and DLCO was noted during the whole pretransplant time period of antifibrotic therapy. Functional exercise capacity and lung allocation score remained unchanged. No post-operative thoracic wound healing problems, nor severe early anastomotic airway complications were attributable to prior antifibrotic treatment. None of the patients developed chronic lung allograft dysfunction after a median follow-up of 19.8 (11.2-26.5) months; and post-transplant survival was 100% after 1 year and 80% after 2 years.

Conclusions: Antifibrotic drugs can probably be safely administered in IPF patients, possibly attenuating disease progression over time, while awaiting LTx.

Keywords: Antifibrotics; IPF; Lung transplantation; Nintedanib; Pirfenidone; Safety.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Belgium
  • Disease Progression
  • Female
  • Graft Survival
  • Humans
  • Idiopathic Pulmonary Fibrosis / therapy*
  • Indoles / adverse effects
  • Indoles / therapeutic use*
  • Lung / physiopathology
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Pyridones / adverse effects
  • Pyridones / therapeutic use*
  • Retrospective Studies
  • Tertiary Care Centers
  • Vital Capacity

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Indoles
  • Pyridones
  • pirfenidone
  • nintedanib