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Moncomble E, Weisenburger G, Picard C, Dégot T, Reynaud-Gaubert M, Nieves A, Mornex JF, Dauriat G, Messika J, Godet C, Hirschi S, Le Pavec J, Borie R, Mordant P, Lortat-Jacob B, Mal H, Bunel V. Effect of antifibrotic agents on postoperative complications after lung transplantation for idiopathic pulmonary fibrosis. Respirology 2024; 29:71-79. [PMID: 37789612 DOI: 10.1111/resp.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Antifibrotic agents (AFAs) are now standard-of-care for idiopathic pulmonary fibrosis (IPF). Concerns have arisen about the safety of these drugs in patients undergoing lung transplantation (LTx). METHODS We performed a multi-centre, nationwide, retrospective, observational study of French IPF patients undergoing LTx between 2011 and 2018 to determine whether maintaining AFAs in the peri-operative period leads to increased bronchial anastomoses issues, delay in skin healing and haemorrhagic complications. We compared the incidence of post-operative complications and the survival of patients according to AFA exposure. RESULTS Among 205 patients who underwent LTx for IPF during the study period, 58 (28%) had received AFAs within 4 weeks before LTx (AFA group): pirfenidone in 37 (18.0%) and nintedanib in 21 (10.2%). The median duration of AFA treatment before LTx was 13.8 (5.6-24) months. The AFA and control groups did not significantly differ in airway, bleeding or skin healing complications (p = 0.91, p = 0.12 and p = 0.70, respectively). Primary graft dysfunction was less frequent in the AFA than control group (26% vs. 43%, p = 0.02), and the 90-day mortality was lower (7% vs. 18%, p = 0.046). CONCLUSIONS AFA therapy did not increase airway, bleeding or wound post-operative complications after LTx and could be associated with reduced rates of primary graft dysfunction and 90-day mortality.
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Affiliation(s)
- Elsa Moncomble
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Gaelle Weisenburger
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | | | - Tristan Dégot
- Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie-Maladies Pulmonaires Rares-Centre de Transplantation Pulmonaire, Hôpital Nord, Marseille, France
| | - Ana Nieves
- Service de Pneumologie-Maladies Pulmonaires Rares-Centre de Transplantation Pulmonaire, Hôpital Nord, Marseille, France
| | - Jean François Mornex
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, Lyon, France
| | - Gaelle Dauriat
- Service de Transplantation, Chirurgie Thoracique et Vasculaire, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Jonathan Messika
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Cendrine Godet
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Sandrine Hirschi
- Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Jérôme Le Pavec
- Service de Transplantation, Chirurgie Thoracique et Vasculaire, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Pierre Mordant
- Service de Chirurgie Thoracique, Hôpital Bichat, Paris, France
| | | | - Hervé Mal
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Vincent Bunel
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
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Risk of anastomotic dehiscence in patients with pulmonary fibrosis transplanted while receiving anti-fibrotics: Experience of the Australian Lung Transplant Collaborative. J Heart Lung Transplant 2019; 38:553-559. [DOI: 10.1016/j.healun.2019.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/11/2019] [Accepted: 02/08/2019] [Indexed: 11/18/2022] Open
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Mortensen A, Cherrier L, Walia R. Effect of pirfenidone on wound healing in lung transplant patients. Multidiscip Respir Med 2018; 13:16. [PMID: 29946463 PMCID: PMC6001132 DOI: 10.1186/s40248-018-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/27/2018] [Indexed: 11/22/2022] Open
Abstract
Background The drug pirfenidone has been shown to slow the progression and decrease mortality of idiopathic pulmonary fibrosis (IPF). Its exact mechanism is unknown, but it likely inhibits pro-fibrotic cytokine transforming growth factor beta, a known contributor to wound healing. We evaluated whether patients taking pirfenidone until lung transplantation had increased risk of impaired wound healing post-transplant. This information could determine whether pirfenidone should be discontinued prior to listing to allow for a wash-out period. Methods We retrospectively reviewed patients who underwent lung transplantation for pulmonary fibrosis at Norton Thoracic Institute in Phoenix, Arizona, from January 2014 to December 2015. Results We describe 18 patients who took pirfenidone up to a month before transplant. Aside from one patient who experienced sternal dehiscence due to a surgical issue, all remaining patients did well with no evidence of airway dehiscence. Each of these 17 patients had been on pirfenidone for at least 30 days; nine patients had been on pirfenidone for over 90 days. Baseline characteristics including age, sex, body mass index, renal function, liver function, glucose level, pre-transplant corticosteroid use, and post-transplant immunosuppressant therapy were similar. Conclusions In our experience, pirfenidone may be safely continued until lung transplantation. Only one patient in our series experienced impaired wound healing related to a surgical issue, even when pirfenidone was continued until lung transplantation. We found no evidence of impaired wound healing or airway complications after lung transplantation in patients who were treated with pirfenidone before lung transplantation.
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Affiliation(s)
- Amber Mortensen
- 1Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA
| | - Lauren Cherrier
- 1Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA
| | - Rajat Walia
- 2Division of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Ste. 500, Phoenix, AZ USA
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Lancaster LH, de Andrade JA, Zibrak JD, Padilla ML, Albera C, Nathan SD, Wijsenbeek MS, Stauffer JL, Kirchgaessler KU, Costabel U. Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 26:26/146/170057. [PMID: 29212837 PMCID: PMC9488585 DOI: 10.1183/16000617.0057-2017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/07/2017] [Indexed: 12/31/2022] Open
Abstract
Pirfenidone is one of two approved therapies for the treatment of idiopathic pulmonary fibrosis (IPF). Randomised controlled clinical trials and subsequent post hoc analyses have demonstrated that pirfenidone reduces lung function decline, decreases mortality and improves progression-free survival. Long-term extension trials, registries and real-world studies have also shown similar treatment effects with pirfenidone. However, for patients with IPF to obtain the maximum benefits of pirfenidone treatment, the potential adverse events (AEs) associated with pirfenidone need to be managed. This review highlights the well-known and established safety profile of pirfenidone based on randomised controlled clinical trials and real-world data. Key strategies for preventing and managing the most common pirfenidone-related AEs are described, with the goal of maximising adherence to pirfenidone with minimal AEs. Using key strategies to prevent and manage pirfenidone-related AEs can help maximise adherence to pirfenidonehttp://ow.ly/Veyk30gsFTs
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Affiliation(s)
| | | | | | - Maria L Padilla
- Mount Sinai - National Jewish Health Respiratory Institute, New York, NY, USA
| | | | | | | | | | | | - Ulrich Costabel
- Ruhrlandklinik, University of Duisberg-Essen, Essen, Germany
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Delanote I, Wuyts WA, Yserbyt J, Verbeken EK, Verleden GM, Vos R. Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series. BMC Pulm Med 2016; 16:156. [PMID: 27863518 PMCID: PMC5116160 DOI: 10.1186/s12890-016-0308-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/06/2016] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Isabelle Delanote
- Department of Respiratory Diseases, Interstitial Lung Disease and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Department of Respiratory Diseases, Interstitial Lung Disease and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium.,KULeuven, Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Laboratory of Respiratory Diseases, Lung Transplantation Unit, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, Interstitial Lung Disease and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium
| | | | - Geert M Verleden
- Department of Respiratory Diseases, Interstitial Lung Disease and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium.,KULeuven, Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Laboratory of Respiratory Diseases, Lung Transplantation Unit, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, Interstitial Lung Disease and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium. .,KULeuven, Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Laboratory of Respiratory Diseases, Lung Transplantation Unit, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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