ArticleTransplant international : official journal of the European Society for Organ Transplantation2026
Impact of pre-transplantation exposure to immunosuppressive agents on lung transplant outcomes in interstitial lung disease.
Article in Transplant international : official journal of the European Society for Organ Transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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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