ORIGINAL RESEARCH
Transpl. Int.
Impact of pre-transplantation exposure to immunosuppressive agents on lung transplant outcomes in interstitial lung disease
- KT
Karim Tazibet 1,2
- VB
Vincent BUNEL 1
- HM
Hervé Mal 1
- TG
Tiphaine Goletto 1
- PH
Pierre Halitim 1
- LM
Lise Morer 1
- DM
Domitille Mouren 1
- MS
Mathilde Salpin 1
- AS
Adèle Sandot 1
- GW
Gaëlle Weisenburger 1
- PM
Philippe MONTRAVERS 1
- EA
Enora Atchade 1
- ST
Sébastien TANAKA 1
- JF
Justine Frija-Masson 1
- LH
Linda Hajouji 1
- YC
Yves Castier 1
- PM
Pierre Mordant 1
- BC
Bruno Crestani 1
- RB
Raphaël Borie 1
- KE
Kinan El Husseini 1
1. Hopital Bichat - Claude-Bernard, Paris, France
2. Centre Hospitalier Universitaire de Lille, Lille, France
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Abstract
Background: Fibrosing interstitial lung diseases (ILDs) are the leading cause of lung transplantation (LTx), with worse outcomes 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. Methods: 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. Primary outcome was 12-month retransplantation-free survival. Systemic steroids exposure was used to adjust analysis. Results: Among 209 patients included, 76 (36%) had received IA within 1 year of LTx. 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). Conclusion: IA exposure in the year before LTx leads to early complications and worse 12-month survival.
Summary
Keywords
corticosteroid therapy, Immunosuppressants, interstitial lung disease, lung transplantation, selection criteria
Received
10 March 2026
Accepted
28 May 2026
Copyright
© 2026 Tazibet, BUNEL, Mal, Goletto, Halitim, Morer, Mouren, Salpin, Sandot, Weisenburger, MONTRAVERS, Atchade, TANAKA, Frija-Masson, Hajouji, Castier, Mordant, Crestani, Borie and El Husseini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Kinan El Husseini, kinan.elhusseini@aphp.fr
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