A best evidence topic was written according to a structured protocol. The question addressed was: ‘Does continuation of antifibrotics before lung transplantation (LTx) influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis (IPF) with regard to mortality, bronchial anastomotic dehiscence, reoperation for bleeding and wound complications, primary graft dysfunction or longer-term survival and allograft rejection?’ A total of 261 articles were found using the reported search strategy, of which 7 represented the best evidence to answer the clinical question. Six out of 7 studies demonstrated equivalent post-transplant survival among IPF patients on antifibrotics before LTx compared with controls. Five out of 6 studies showed no increase in the risk of major bleeding, wound or bronchial anastomotic complications. One bi-institutional study found a higher incidence of early bronchial anastomotic dehiscence, but this difference was not statistically significant after longer term follow-up. In a study that only included IPF patients who underwent single LTx, a lower incidence of grade 3 primary graft dysfunction was reported in the antifibrotic group compared with controls. Overall, to date, only small (N < 40 in the antifibrotic group), non-risk-adjusted, retrospective observational studies have been published. Notwithstanding, the summation of available evidence suggests that, in IPF patients, continuation of antifibrotic therapy before LTx is likely safe, and the rates of perioperative bleeding, wound or bronchial anastomotic complications, as well as 30-day and 1-year survival, are similar to patients not on antifibrotics before LTx.

中文翻译：

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肺移植前继续使用抗纤维化药物会影响特发性肺纤维化患者的移植后结果吗？

最佳证据主题是根据结构化协议编写的。解决的问题是：“在肺移植 (LTx) 前继续使用抗纤维化药物是否会影响特发性肺纤维化 (IPF) 患者的移植后结局，包括死亡率、支气管吻合口裂开、因出血和伤口并发症再次手术、原发性移植物功能障碍或长期生存和同种异体排斥？使用报告的搜索策略共找到 261 篇文章，其中 7 篇是回答临床问题的最佳证据。7 项研究中有 6 项显示，与对照组相比，在 LTx 之前使用抗纤维化药物的 IPF 患者的移植后存活率相当。6 项研究中有 5 项显示大出血、伤口或支气管吻合口并发症的风险没有增加。一项双机构研究发现早期支气管吻合口裂开的发生率较高，但这种差异在长期随访后无统计学意义。在一项仅包括接受单次 LTx 的 IPF 患者的研究中，与对照组相比，抗纤维化组的 3 级原发性移植物功能障碍发生率较低。总的来说，迄今为止，只有很小的（抗纤维化组N < 40），已发表非风险调整的回顾性观察研究。尽管如此，现有证据的总和表明，在 IPF 患者中，在 LTx 之前继续抗纤维化治疗可能是安全的，并且围手术期出血、伤口或支气管吻合并发症的发生率以及 30 天和 1 年生存率是类似于在 LTx 之前未使用抗纤维化药物的患者。