RT Journal Article
SR Electronic
T1 A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 164
OP 172
DO 10.1183/09031936.00068310
VO 37
IS 1
A1 R. Vos
A1 B.M. Vanaudenaerde
A1 S.E. Verleden
A1 S.I. De Vleeschauwer
A1 A. Willems-Widyastuti
A1 D.E. Van Raemdonck
A1 A. Schoonis
A1 T.S. Nawrot
A1 L.J. Dupont
A1 G.M. Verleden
YR 2011
UL http://erj.ersjournals.com/content/37/1/164.abstract
AB Azithromycin reduces airway inflammation and improves forced expiratory volume in 1 s (FEV1) in chronic rejection or bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Azithromycin prophylaxis might prevent BOS. A double-blind randomised controlled trial of azithromycin (n = 40) or placebo (n = 43), initiated at discharge and administered three times a week for 2 yrs, was performed in 2005–2009 at the Leuven University Hospital (Leuven, Belgium). Primary end-points were BOS-free and overall survival 2 yrs after LTx; secondary end-points were acute rejection, lymphocytic bronchiolitis and pneumonitis rate, prevalence of pseudomonal airway colonisation or gastro-oesophageal reflux, and change in FEV1, airway and systemic inflammation over time. Patients developing BOS were assessed for change in FEV1 with open-label azithromycin. BOS occurred less in patients receiving azithromycin: 12.5 versus 44.2% (p = 0.0017). BOS-free survival was better with azithromycin (hazard ratio 0.27, 95% CI 0.092–0.816; p = 0.020). Overall survival, acute rejection, lymphocytic bronchiolitis, pneumonitis, colonisation and reflux were comparable between groups. Patients receiving azithromycin demonstrated better FEV1 (p = 0.028), and lower airway neutrophilia (p = 0.015) and systemic C-reactive protein levels (p = 0.050) over time. Open-label azithromycin for BOS improved FEV1 in 52.2% patients. No serious adverse events were noted. Azithromycin prophylaxis attenuates local and systemic inflammation, improves FEV1 and reduces BOS 2 yrs after LTx.