Impact of pre-transplantation exposure to immunosuppressive agents on lung transplant outcomes in interstitial lung disease

Résumé fourni par la source

Fibrosing interstitial lung diseases (ILDs) are the leading cause of lung transplantation (LTx), with worse results than other indications. We hypothesised that exposure to non-steroidal immunosuppressive agents (IAs) in the year preceding LTx for ILD may result in poorer early outcomes. We retrospectively analysed adults who underwent LTx for ILD from April 2011 to June 2024 in our institution and compared patients who received IA within 1 year before LTx to those who did not (systemic steroids exposure was used to adjust analysis). The primary outcome was 12-month retransplantation-free survival. Among 209 patients included, 76 (36%) had received IA within 1 year of LTx, and these patients had significantly worse 12-month retransplantation-free survival on multivariate analysis (62% vs. 80%; HR 1.99, 95%CI [1.11-3.56], p = 0.022); IA exposure increased the odds of grade 3 PGD (OR 3.20 [1.42-7.45], p = 0.005), bronchovascular fistula (OR 9.43, 95% CI [1.48-183], p = 0.042), pneumonia episodes in the first 6 months (median 2 [IQR 1-4] vs. 1 [0.5-2.5], p = 0.001), cytomegalovirus viremia under prophylaxis (21% vs. 5.2%, p = 0.005) and incidence of ganciclovir-resistant cytomegalovirus (14% vs. 3.2%, p = 0.021). In conclusion, IA exposure in the year before LTx leads to early complications and worse 12-month survival.

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