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A6571 - Nintedanib Exposure Prior to Lung Transplantation as a Possible Risk Factor for Post-Operative Complications
Author Block: C. Rutherford, P. Ging, J. Kleinerova, J. Egan; Heart Lung Transplant Program, Mater Misericordiae University Hospital, Dublin, Ireland.
Introduction
Nintedanib has been shown to reduce the rate of decline in lung function in patients with idiopathic pulmonary fibrosis (IPF). It is a tyrosine kinase inhibitor which has a mechanism of action that may potentially cause perioperative complications such as increased bleeding risk, impaired wound healing and gastrointestinal perforation. There is very little published data to indicate if previous Nintedanib exposure is a risk factor for post-operative complications following lung transplant.
Our Centre has significant experience in performing single lung transplants for older patients with IPF. In this case series we present all three patients with IPF who received a transplant following previous exposure to Nintedanib.
Case one
A 68 year old man was commenced on Nintedanib 150mg BD during the TOMORROW trial in May 2008. He and remained on the drug until September 2009 (total duration 17 months). He received a right single lung transplant in June 2013. His perioperative care was uneventful until he developed an acute abdomen secondary to a perforated sigmoid colon, leading to death nine days post-transplant.
Case two
A 69 year old man, who received Nintedanib for a total of 33 months between May 2008 and February 2011, received a right single lung transplant in March 2012. He had multiple post-operative complications including a persistent pneumothorax and Pseudomonas pneumonia, resulting in failure to wean from ventilation. He required a left single lung transplant in September 2012 which was complicated by a large thoracic haematoma, requiring a thoracotomy and evacuation on day 12 post-transplant. He was discharged after three months, and survived for 29 months following his second transplant.
Case three
A 60 year old man taking Nintedanib for a total of 15 months between March 2015 and May 2016, proceeded to a right single lung transplant in August 2016. His post-operative course was complicated by donor acquired pneumonia and ischaemic airway anastomosis. He was discharged home after 5 weeks in hospital.
Summary
Although a causal link cannot be determined from this case series, all three patients suffered multiple complications. These patients appear to have an increased length of hospital admission and increased mortality compared to our Centre’s average. As more patients with IPF are commenced on Tyrosine Kinase Inhibitors to delay the need for lung transplantation, further research is required to assess the potential long term risks of previous Nintedanib exposure and post-operative complication rates.