Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis
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 anti...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/2/655 |
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| author | Pahnwat Taweesedt Ploypin Lertjitbanjong Dararat Eksombatchai Prangthip Charoenpong Teng Moua Charat Thongprayoon Supawit Tangpanithandee Tananchai Petnak |
| author_facet | Pahnwat Taweesedt Ploypin Lertjitbanjong Dararat Eksombatchai Prangthip Charoenpong Teng Moua Charat Thongprayoon Supawit Tangpanithandee Tananchai Petnak |
| author_sort | Pahnwat Taweesedt |
| collection | DOAJ |
| description | 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; <i>I</i><sup>2</sup> = 0%), anastomotic complications (RR 0.88; 95% CI, 0.37–2.12; <i>I</i><sup>2</sup> = 31%), bleeding complications (RR 0.76; 95% CI, 0.33–1.76; <i>I</i><sup>2</sup> = 0%), or primary graft dysfunction (RR 0.87; 95% CI, 0.59–1.29; <i>I</i><sup>2</sup> = 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; <i>I</i><sup>2</sup> = 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. |
| first_indexed | 2024-03-09T12:10:57Z |
| format | Article |
| id | doaj.art-a867f9640d404568bad0d978abd64f12 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T12:10:57Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a867f9640d404568bad0d978abd64f122023-11-30T22:53:01ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112265510.3390/jcm12020655Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-AnalysisPahnwat Taweesedt0Ploypin Lertjitbanjong1Dararat Eksombatchai2Prangthip Charoenpong3Teng Moua4Charat Thongprayoon5Supawit Tangpanithandee6Tananchai Petnak7Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94305, USADivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USADivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, ThailandDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USADivision of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USAChakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, ThailandDivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, ThailandAntifibrotic 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; <i>I</i><sup>2</sup> = 0%), anastomotic complications (RR 0.88; 95% CI, 0.37–2.12; <i>I</i><sup>2</sup> = 31%), bleeding complications (RR 0.76; 95% CI, 0.33–1.76; <i>I</i><sup>2</sup> = 0%), or primary graft dysfunction (RR 0.87; 95% CI, 0.59–1.29; <i>I</i><sup>2</sup> = 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; <i>I</i><sup>2</sup> = 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.https://www.mdpi.com/2077-0383/12/2/655interstitial lung diseaselung transplantationantifibroticpirfenidonenintedanibcomplication |
| spellingShingle | Pahnwat Taweesedt Ploypin Lertjitbanjong Dararat Eksombatchai Prangthip Charoenpong Teng Moua Charat Thongprayoon Supawit Tangpanithandee Tananchai Petnak Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis Journal of Clinical Medicine interstitial lung disease lung transplantation antifibrotic pirfenidone nintedanib complication |
| title | Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis |
| title_full | Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis |
| title_fullStr | Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis |
| title_short | Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis |
| title_sort | impact of antifibrotic treatment on postoperative complications in patients with interstitial lung diseases undergoing lung transplantation a systematic review and meta analysis |
| topic | interstitial lung disease lung transplantation antifibrotic pirfenidone nintedanib complication |
| url | https://www.mdpi.com/2077-0383/12/2/655 |
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