Taweesedt Pahnwat, Lertjitbanjong Ploypin, Eksombatchai Dararat, Charoenpong Prangthip, Moua Teng, Thongprayoon Charat, Tangpanithandee Supawit, Petnak Tananchai
Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
J Clin Med. 2023 Jan 13;12(2):655. doi: 10.3390/jcm12020655.
Antifibrotic treatment has been approved for reducing disease progression in fibrotic interstitial lung disease (ILD). As a result of increased bleeding risk, some experts suggest cessation of antifibrotics prior to lung transplantation (LT). However, extensive knowledge regarding the impact of antifibrotic treatment on postoperative complications remains unclear. We performed a comprehensive search of several databases from their inception through to 30 September 2021. Original studies were included in the final analysis if they compared postoperative complications, including surgical wound dehiscence, anastomosis complication, bleeding complications, and primary graft dysfunction, between those with and without antifibrotic treatment undergoing LT. Of 563 retrieved studies, 6 studies were included in the final analysis. A total of 543 ILD patients completing LT were included, with 161 patients continuing antifibrotic treatment up to the time of LT and 382 without prior treatment. Antifibrotic treatment was not significantly associated with surgical wound dehiscence (RR 1.05; 95% CI, 0.31-3.60; = 0%), anastomotic complications (RR 0.88; 95% CI, 0.37-2.12; = 31%), bleeding complications (RR 0.76; 95% CI, 0.33-1.76; = 0%), or primary graft dysfunction (RR 0.87; 95% CI, 0.59-1.29; = 0%). Finally, continuing antifibrotic treatment prior to LT was not significantly associated with decreased 1-year mortality (RR 0.80; 95% CI, 0.41-1.58; = 0%). Our study suggests a similar risk of postoperative complications in ILD patients undergoing LT who received antifibrotic treatment compared to those not on antifibrotic therapy.
抗纤维化治疗已被批准用于减缓纤维化间质性肺病（ILD）的疾病进展。由于出血风险增加，一些专家建议在肺移植（LT）前停用抗纤维化药物。然而，关于抗纤维化治疗对术后并发症影响的广泛知识仍不明确。我们对几个数据库从创建到2021年9月30日进行了全面检索。如果原始研究比较了接受LT的抗纤维化治疗患者与未接受抗纤维化治疗患者之间的术后并发症，包括手术伤口裂开、吻合口并发症、出血并发症和原发性移植物功能障碍，则纳入最终分析。在检索到的563项研究中，6项研究纳入最终分析。总共纳入了543例完成LT的ILD患者，其中161例患者在LT时继续接受抗纤维化治疗，382例患者未接受过先前治疗。抗纤维化治疗与手术伤口裂开（RR 1.05；95%CI，0.31 - 3.60；P = 0%）、吻合口并发症（RR 0.88；95%CI，0.37 - 2.12；P = 31%）、出血并发症（RR 0.76；95%CI，0.33 - 1.76；P = 0%）或原发性移植物功能障碍（RR 0.87；95%CI，0.59 - 1.29；P = 0%）均无显著相关性。最后，LT前继续抗纤维化治疗与1年死亡率降低无显著相关性（RR 0.80；95%CI，0.41 - 1.58；P = 0%）。我们的研究表明，接受抗纤维化治疗的ILD患者在LT术后发生并发症的风险与未接受抗纤维化治疗的患者相似。
