Optimizing patient outcomes in interstitial lung disease through pre- and post-transplant management strategies

Table 1 Pharmacological agents used pre- and post-transplantation and their characteristics

Pharmacological agent	Advantages	Disadvantages	Potential side effects	Ref.
Prednisone	Effective for hypersensitivity pneumonitis and autoimmune ILD	Long-term use leads to osteoporosis, hyperglycemia, and adrenal suppression	Hypertension, osteoporosis, hyperglycemia, mood changes	[39]
Azathioprine	Used for autoimmune-associated ILD, suppresses immune response	Risk of bone marrow suppression and hepatotoxicity	Bone marrow suppression, hepatotoxicity, nausea	[40]
Mycophenolate mofetil	First-line for autoimmune ILD, better tolerance than azathioprine	Risk of gastrointestinal side effects and leukopenia	Leukopenia, GI distress, increased infection risk	[40]
Pirfenidone	Slows disease progression in fibrotic ILDs	Photosensitivity, gastrointestinal intolerance	Nausea, rash, weight loss, fatigue	[41,42]
Nintedanib	Reduces lung function decline in fibrotic ILDs	Diarrhea, hepatic toxicity, increased risk of bleeding	Diarrhea, hepatic enzyme elevation, loss of appetite	[41,44]
Tacrolimus	Reduces acute rejection rates in lung transplantation	Nephrotoxicity, neurotoxicity, risk of post-transplant diabetes	Kidney dysfunction, hyperkalemia, diabetes	[62,63]
Sirolimus	Potentially reduces incidence of chronic lung allograft dysfunction	Delayed wound healing, risk of pneumonitis	Mouth ulcers, thrombocytopenia, lung toxicity	[65]

GI: Gastrointestinal; ILD: Interstitial lung disease.