Original clinical scienceAzithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome
Section snippets
Study design
Institutional review board approval for this study was obtained prior to data acquisition. A retrospective review of medical records was conducted on consecutive adult patients (age ≥18 years) at WUSM/BJH who underwent lung transplantation between August 1, 1998 and June 30, 2004. Follow-up data were accrued on all eligible recipients until death or through January 1, 2008. Demographic and clinical characteristics were obtained from medical records and computerized databases. Recipients were
Cohort assembly and baseline comparison
Of the 297 patients who received a lung transplant at WUSM/BJH between August 1, 1998 and June 30, 2004, 106 were excluded because they did not develop BOS Stage 1 prior to January 1, 2008. During the follow-up period, 9 recipients were excluded due to death within 90 days of transplantation, and 3 were excluded because they did not have pulmonary function testing due to chronic tracheostomy. In our study population of 179 lung transplant recipients with BOS Stage ≥1, there were 95 patients who
Discussion
In this study, azithromycin treatment was associated with improved survival when analyzed as a time-dependent variable. This mortality benefit remained present even after adjusting for type of transplant, acute rejection scores, CARV infections, history of Pseudomonas in respiratory specimens, absolute FEV1 at BOS Stage 1, and anti-thymocyte globulin treatment of BOS Stage 1. In addition, our data suggest that initiation of azithromycin for BOS should begin prior to the progression to BOS Stage
Disclosure statement
We thank M. Gibson for help with data collection and J. Fassler, T. Francescon, C. Miller, W. Panus, L. Roldan, S. Rupp and M. Scavuzzo for assistance with chart reviews.
Supported by Grants T32 HL007317 and R01HL083894 from the National Institutes of Health/National Heart, Lung, and Blood Institute.
No authors involved in the preparation of this manuscript have any financial relationships with industry or other agencies related to azithromycin or other macrolide antibiotics.
References (32)
- et al.
Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart–lung transplantation report—2007
J Heart Lung Transplant
(2007) - et al.
Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/lung transplantation report—2008
J Heart Lung Transplant
(2008) - et al.
Long-term azithromycin may improve lung function in children with cystic fibrosis
Lancet
(1998) - et al.
Long-term azithromycin use for treatment of bronchiolitis obliterans syndrome in lung transplant recipients
J Heart Lung Transplant
(2005) - et al.
Minimal acute rejection after lung transplantation: a risk for bronchiolitis obliterans syndrome
Am J Transplant
(2005) - et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Report of the ISHLT working group on primary lung graft dysfunctionPart II: Definition. A consensus statement of the International Society for Heart and Lung Transplantation
J Heart Lung Transplant
(2005) - et al.
Bronchiolitis obliterans in single-lung transplant recipients
Chest
(1995) - et al.
Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation
Chest
(2000) - et al.
Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease
Ann Thorac Surg
(2004)