Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11102
Title: Long-term azithromycin therapy for bronchiolitis obliterans syndrome: Divide and conquer?
Authors: Robin, Vos
Vanaudenaerde, BM
Ottevaere, A
Verleden, SE
De Vleeschauwer, SI
WIDYASTUTI, Anna 
WAUTERS, Shana
Van Raemdonck, DE
NAWROT, Tim 
Dupont LJ
Verleden GM
Issue Date: 2010
Publisher: Elsevier Science
Source: JOURNAL OF HEART AND LUNG TRANSPLANTATION, 29(12). p. 1358-1368
Abstract: BACKGROUND: Azithromycin may reverse or halt the decline of pulmonary function (FEV(1)) in bronchiolitis obliterans syndrome (BOS). In this study we investigated the effects of long-term azithromycin treatment in lung transplant recipients with BOS. METHODS: A retrospective, observational, cohort study was performed on 107 patients with BOS (Stages 0p/1/2/3, n = 23/62/20/2), who were treated with azithromycin for 3.1 +/- 1.9 years. Patients were evaluated 6.3 +/- 3.8 years after transplantation and assessed for evolution of FEV(1), bronchoalveolar lavage neutrophilia and overall survival after initiation of azithromycin. Survival curves were analyzed using the log-rank test. Cox proportional hazard survival regression analysis was performed to estimate hazard ratios of clinical variables predicting outcome. RESULTS: FEV(1) increased >/=10% after 3 to 6 months of treatment in 40% of patients, of whom 33% later redeveloped BOS. FEV(1) further declined in 78% and stabilized in 22% of the remaining non-responders. Pre-treatment neutrophilia was higher in responders: 29.3% (9.3% to 69.7%) vs 11.5% (2.9% to 43.8%) (p = 0.025), in whom it significantly decreased to 4.2% (1.8% to 17.6%) (p = 0.041) after 3 to 6 months of azithromycin. Responders demonstrated better survival compared with non-responders (p = 0.050), with 6 and 21 patients, respectively, dying during follow-up (p = 0.027). Multivariate analysis identified initial azithromycin response and earlier post-transplant initiation of azithromycin to be protective for both BOS progression/relapse (hazard ratio [HR] = 0.12 [95% confidence interval 0.05 to 0.28], p < 0.0001; and HR = 0.98 [95% confidence interval 0.97 to 0.98], p < 0.0001, respectively) and retransplantation/death during follow-up (HR 0.10 [95% confidence interval 0.02 to 0.48], p = 0.004; and HR 0.96 [95% confidence interval 0.95 to 0.98], p < 0.0001, respectively). CONCLUSIONS: Long-term azithromycin benefits pulmonary function and survival in BOS, particularly in patients with increased lavage neutrophilia.
Notes: Laboratory of Pneumology, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, Leuven, Belgium.
Keywords: azithromycin;bronchiolitis obliterans;syndrome;chronic allograft rejection;pulmonary function survival;survival
Document URI: http://hdl.handle.net/1942/11102
ISSN: 1053-2498
e-ISSN: 1557-3117
DOI: 10.1016/j.healun.2010.05.023
ISI #: 000285220700006
Rights: 2010 International Society for Heart and Lung Transplantation All rights reserved
Category: A1
Type: Journal Contribution
Validations: ecoom 2012
Appears in Collections:Research publications

Show full item record

SCOPUSTM   
Citations

76
checked on Sep 2, 2020

WEB OF SCIENCETM
Citations

75
checked on May 14, 2022

Page view(s)

78
checked on May 20, 2022

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.