This review aims to provide an overview of pre-transplant antifibrotic therapy on peri-transplant outcomes and to address the possible role of antifibrotics in lung transplant recipients with chronic lung allograft dysfunction.

Lung transplantation is an established treatment modality for patients with various end-stage lung diseases, of which idiopathic pulmonary fibrosis and other progressive fibrosing interstitial lung diseases are growing indications. Theoretically, widespread use of antifibrotics prior to lung transplantation may increase the risk of bronchial anastomotic complications and impaired wound healing.

Long-term graft and patient survival are still hampered by development of chronic lung allograft dysfunction, on which antifibrotics may have a beneficial impact.

Antifibrotics until the moment of lung transplantation proved to be safe, without increasing peri-transplant complications. Currently, best practice is to continue antifibrotics until time of transplantation. In a large multicentre randomised trial, pirfenidone did not appear to have a beneficial effect on lung function decline in established bronchiolitis obliterans syndrome. The results of antifibrotic therapy in restrictive allograft syndrome are eagerly awaited, but nonrandomised data from small case reports/series are promising.

本综述旨在概述移植前抗纤维化治疗对围移植结局的影响，并探讨抗纤维化药物在患有慢性肺同种异体移植物功能障碍的肺移植受者中可能发挥的作用。

肺移植是各种终末期肺病患者的既定治疗方式，其中特发性肺纤维化和其他进行性纤维化间质性肺病的适应症越来越多。从理论上讲，肺移植前广泛使用抗纤维化药物可能会增加支气管吻合口并发症和伤口愈合受损的风险。

长期移植物和患者的生存仍然受到慢性肺同种异体移植物功能障碍的阻碍，抗纤维化药物可能对此产生有益影响。

直到肺移植那一刻，抗纤维化药物被证明是安全的，不会增加围移植期并发症。目前，最佳做法是在移植前继续使用抗纤维化药物。在一项大型多中心随机试验中，吡非尼酮似乎对确定的闭塞性细支气管炎综合征患者的肺功能下降没有有益作用。人们热切期待限制性同种异体移植综合征的抗纤维化治疗结果，但来自小病例报告/系列的非随机数据很有希望。