Munker Dieter, Arnold Paola, Leuschner Gabriela, Irlbeck Michael, Michel Sebastian, Kauke Teresa, Meiser Bruno, Behr Jürgen, Kneidinger Nikolaus, Veit Tobias
Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany.
Department of Anaesthesiology, University of Munich (LMU), 81377 Munich, Germany.
J Clin Med. 2023 Jul 29;12(15):4996. doi: 10.3390/jcm12154996.
Immunosuppressants and antifibrotics are currently used to treat patients with various interstitial lung diseases, which may undergo lung transplantation (LTx). The retrospective study aimed to evaluate the potential effects of therapeutic regimen on the perioperative course in patients with idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF) undergoing LTx. All patients with IPF and PPF undergoing LTx between January 2014 and December 2021 were included. We retrospectively screened for previous use of immunosuppressants and antifibrotic therapy. We analyzed perioperative courses, short-term outcomes, and safety retrospectively. In total, 286 patients with diagnosis of IPF or PPF were analyzed. According to the treatment regimen before LTx, the study cohort was divided into four groups and compared. No differences between antifibrotic monotherapy, combined antifibrotic and immunosuppressive therapy with regard to postoperative complications were observed. Length of mechanical ventilation was shorter in patients with antifibrotics prior to LTx. Pretreatment with antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy, lower body mass index (BMI) and lower blood loss, were independently associated with primary graft dysfunction grades 0-3 72 hours after LTx ( < 0.001). Finally, patients with antifibrotic monotherapy developed significantly less de novo donor-specific antibodies (DSA) ( = 0.009). Higher intraoperative blood loss, etiology of interstitial lung disease (ILD) and older age were independently associated with shorter survival after LTx. Use of antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy in IPF/PPF patients undergoing LTx, proved to be safe and might lead to beneficial effects after LTx.
免疫抑制剂和抗纤维化药物目前用于治疗各种可能接受肺移植（LTx）的间质性肺病患者。这项回顾性研究旨在评估治疗方案对接受LTx的特发性肺纤维化（IPF）或进行性肺纤维化（PPF）患者围手术期过程的潜在影响。纳入了2014年1月至2021年12月期间所有接受LTx的IPF和PPF患者。我们回顾性筛查了既往免疫抑制剂和抗纤维化治疗的使用情况。我们回顾性分析了围手术期过程、短期结局和安全性。总共分析了286例诊断为IPF或PPF的患者。根据LTx前的治疗方案，将研究队列分为四组并进行比较。在术后并发症方面，未观察到抗纤维化单药治疗、抗纤维化与免疫抑制联合治疗之间存在差异。LTx前使用抗纤维化药物的患者机械通气时间较短。抗纤维化单药治疗以及抗纤维化药物与免疫抑制治疗联合预处理、较低的体重指数（BMI）和较少的失血量，与LTx后72小时原发性移植物功能障碍0 - 3级独立相关（<0.001）。最后，接受抗纤维化单药治疗的患者新产生的供者特异性抗体（DSA）明显较少（=0.009）。术中失血量较多、间质性肺病（ILD）病因和年龄较大与LTx后较短的生存期独立相关。在接受LTx的IPF/PPF患者中使用抗纤维化单药治疗以及抗纤维化药物与免疫抑制治疗联合，被证明是安全的，并且可能在LTx后产生有益效果。
