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Antifibrotic drugs in lung transplantation and chronic lung allograft dysfunction: a review

Saskia Bos, Laurens J. De Sadeleer, Arno Vanstapel, Hanne Beeckmans, Annelore Sacreas, Jonas Yserbyt, Wim A. Wuyts, Robin Vos
European Respiratory Review 2021 30: 210050; DOI: 10.1183/16000617.0050-2021
Saskia Bos
1Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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  • For correspondence: saskia.bos@uzleuven.be
Laurens J. De Sadeleer
2Dept of Respiratory Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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  • ORCID record for Laurens J. De Sadeleer
Arno Vanstapel
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Hanne Beeckmans
4Dept of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
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  • ORCID record for Hanne Beeckmans
Annelore Sacreas
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Jonas Yserbyt
1Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Wim A. Wuyts
1Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Robin Vos
1Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
3Dept of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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    FIGURE 1

    Overview of normal lungs, idiopathic pulmonary fibrosis (IPF), bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). a) Normal lungs: chest computed tomography (CT), axial pulmonary window: normal lung parenchyma. Haematoxylin and eosin (HE) staining illustrates normally preserved lung parenchyma. b) IPF: chest CT, axial pulmonary window: i) peripheral subpleural reticulation and traction bronchiectasis; ii) honeycombing (right lower lobe), diffuse areas of consolidation and bronchiectasis. HE staining illustrates prominent honeycombing, characterised by irregular cystic airspaces of varying size, partly filled with mucus and surrounded by fibrotic remodelling. c) BOS: chest CT, axial pulmonary window: i) air trapping; ii) bronchiectasis. HE staining with presence of a typical bronchiolitis obliterans lesion, characterised by concentric subepithelial fibrosis narrowing the airway lumen. d) RAS: chest CT, axial pulmonary window: i) bilateral opacification especially of the left upper lung lobe, volume loss of the left lung, traction bronchiectasis; ii) areas of ground-glass opacification and interlobular septal thickening. Elastica van Gieson stain highlights the presence of prominent pleural fibrosis and subpleural fibroelastosis, consistent with pleuroparenchymal fibroelastosis. Figure partially created with BioRender.com.

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Vol 30 Issue 160 Table of Contents
European Respiratory Review: 30 (160)
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Antifibrotic drugs in lung transplantation and chronic lung allograft dysfunction: a review
Saskia Bos, Laurens J. De Sadeleer, Arno Vanstapel, Hanne Beeckmans, Annelore Sacreas, Jonas Yserbyt, Wim A. Wuyts, Robin Vos
European Respiratory Review Jun 2021, 30 (160) 210050; DOI: 10.1183/16000617.0050-2021

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Antifibrotic drugs in lung transplantation and chronic lung allograft dysfunction: a review
Saskia Bos, Laurens J. De Sadeleer, Arno Vanstapel, Hanne Beeckmans, Annelore Sacreas, Jonas Yserbyt, Wim A. Wuyts, Robin Vos
European Respiratory Review Jun 2021, 30 (160) 210050; DOI: 10.1183/16000617.0050-2021
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  • Article
    • Abstract
    • Abstract
    • Introduction
    • Pirfenidone and nintedanib: two key antifibrotic drugs
    • Antifibrotics in IPF
    • Antifibrotics in non-IPF progressive fibrosing ILD
    • Antifibrotics in ILD patients referred for LTx
    • Mechanisms of antifibrotics on the pathophysiological processes after LTx and in CLAD development
    • Antifibrotics in CLAD phenotype BOS
    • Antifibrotics in CLAD phenotype RAS
    • Future areas of interest
    • Conclusion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

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  • Interstitial and orphan lung disease
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