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Title
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A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation
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Author
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Abstract
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| 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. |
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Language
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English
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Source (journal)
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The European respiratory journal / European Respiratory Society [Lausanne] - Copenhagen, 1988, currens
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Publication
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Copenhagen
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2011
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ISSN
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0903-1936
[print]
1399-3003
[online]
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DOI
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10.1183/09031936.00068310
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Volume/pages
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37
:1
(2011)
, p. 164-172
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ISI
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000285752400025
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Pubmed ID
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20562124
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Full text (Publisher's DOI)
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