Effect of antifibrotic therapy on outcome after single lung transplantation in patients with IPF

Background Observational data suggest that pirfenidone and nintedanib can be applied safely in patients undergoing bilateral lung transplantation. Antifibrotic treatment has been shown to reduce exacerbations, a condition frequently seen in the native lungs of patients with IPF after single lung transplantation (SLTx). Therefore, the aim of this study was to assess the impact of previous treatment with nintedanib and pirfenidone on short-term outcome after SLTx.

Methods All patients with IPF undergoing SLTx at the University of Munich between May 2011 and August 2018 were retrospectively screened for previous use of anti-fibrotic therapy. Baseline parameters and short-term outcome were recorded and analyzed.

Result In total, 56 patients were identified (Lung Allocation Score [mean ± SD] 47.8 ± 15.8). Thereof, 29 patients (52%) received antifibrotic drugs before SLTx (19 pirfenidone and 10 nintedanib, resp.). Baseline characteristics and severity of disease did not differ between groups. Antifibrotic treatment did not increase blood product utilization, wound-healing or anastomotic complications after SLTx. There was a trend for shorter time on mechanical ventilation in patients with previous antifbrotic treatment (67 ± 13 vs. 117 ± 28 h; p = 0.099). Interestingly, acute cellular rejections occurred less frequent in patients with previous antifbrotic treatment within the first 30 days after SLTx (0 vs. 10.7%; p = 0.0091).

Conclusion Preliminary data suggest that previous use of antifibrotic treatment in IPF may be beneficial in patients undergoing SLTx.