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A1630 - Nintedanib and Pirfenidone as a Bridge to Lung Transplant in Idiopathic Pulmonary Fibrosis
Author Block: D. Li1, W. Mason2, H. Hoy1, I. Robbins3, J. Loyd3, L. Lancaster4; 1Vanderbilt University School of Medicine, Nashville, TN, United States, 2Pulmonary Medicine, Vanderbilt University, Nashville, TN, United States, 3Vanderbilt Univ Ctr for Lung Rsch, Nashville, TN, United States, 4Pulmonary and Critical Care Med, Vanderbilt Univ Medical Ctr, Nashville, TN, United States.
Background: Pirfenidone and nintedanib are two antifibrotic drugs recently approved to delay progression of idiopathic pulmonary fibrosis (IPF). Concern exists that these drugs may impair wound healing or contribute to bleeding during transplant. The purpose of this study was to assess the impact of treatment with antifibrotic medications on waiting list survival and peri-operative and post-surgical outcomes after lung transplant. Methods: All IPF patients placed on anti-fibrotic drugs prior to transplant at Vanderbilt University from 2012 to 2017 were identified in this single center retrospective cohort analysis. Peri-operative and post-transplant outcomes were analyzed. Results: 14 patients who received anti-fibrotic medications prior to transplant were identified. 12 of these patients received pirfenidone (lung allocation score (LAS) [median, range] 39.4, 34.3-47.4) and two received nintedanib (LAS 48.9, 46.7-51.2) prior to transplant. No patients placed on pirfenidone or nintedanib died while on the transplant waiting list. One patient required a post-surgical revision secondary to bleeding. Another patient developed a peri-incisional hematoma that required subsequent drainage. The remainder of patients tolerated transplant well. Post-transplant survival was 92% at 3 months and 85% at 1 year. Conclusions: Antifibrotic medications are likely safe for IPF patients awaiting lung transplant; however, further investigation is required.