This is a well-written and well-performed study by Astor et al. with relevant findings which may possibly lead to changes in management. As far as I’m aware, this is the largest study looking at the impact of antifibrotic therapy on LTx complications, and the multicentre setting is absolutely an added value.

I have some minor comments:
- It would be good to give more information regarding the procedures performed across the centres and add this to Table 1 (number of patients per type of surgical approach).
- Related to this: I assume sternal dehiscence happened in patients who got a sternotomy and surgical wound dehiscence refers to patients who got a clamshell or bilateral thoracotomy? It would be good if the authors can clarify this in the methods (now bit confusing as sternal dehiscence is also a form of surgical wound dehiscence).
- What was the definition of sternal dehiscence: any dehiscence or requiring intervention?
- Post-discharge results, Table 3 and S7: would be good if the authors can explain what ‘discharge home’ means. I guess this was at a certain timepoint? (236 of the 283 who were discharged home)
- I would start the discussion with the fact that antifibrotic drugs are increasingly used and not only for IPF but also for other progressive fibrotic ILDs nowadays, putting the relevance of this topic in context
- The authors refer in the discussion to the risk of bleeding, especially correlated with the use of nintedanib. Since the information regarding bleeding is relevant, I’d suggest adding the data from table S5 to the main table (Table 2). It would also be interesting to see if there is a difference in transfusion need between nintedanib and pirfenidone and mention it in the discussion.
- I’d add to the discussion part of protective features/PGD that you also saw in your study that the incidence of PGD was significantly lower in the shorter group.
- The section on the effect of discontinuation on IPF progression is important as we know that discontinuing antifibrotic drugs while on the waiting list might carry some risks. Therefore, it would be better to discuss this as a separate paragraph before the strengths/limitations of the study. Also in your study, the majority of patients who died on the waiting list died shortly after stopping antifibrotic drugs although the numbers are too low to draw conclusions. (but would mention it in the discussion) I like the discussion on taking risk factors/LAS score into account as well as expected waitlist time, and if this risk outweighs the small risk of bronchial and (3.7% of all patients) or sternal dehiscence (4% of all patients).
- P. 10: you use ILD twice, while you used the full name before. Please be consistent and either use the full name throughout or introduce the abbreviation the first time on p. 4.
- Table S4: it is unclear to me which spirometry/DLco measurement the authors refer to.

BTW, I’m surprised by the short waiting time for LTx!

The manuscript has been nicely updated. All my comments have been addressed, and I do not have any further comments.

Nice manuscript. I don't have any comments and agree with the change made based on the other reviewer's suggestion. Nice graphical abstract too.