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Am J Transplant ; 16(1): 254-61, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26372728

ABSTRACT

Prophylactic azithromycin treatment has been demonstrated to improve freedom from bronchiolitis obliterans syndrome (BOS) 2 years after lung transplantation (LTx). In the current study, we re-evaluated the long-term effects of this prophylactic approach in view of the updated classification system for chronic lung allograft dysfunction (CLAD). A retrospective, intention-to-treat analysis of a randomized controlled trial comparing prophylactic treatment with placebo (n = 43) versus azithromycin (n = 40) after LTx was performed. Graft dysfunction (CLAD), graft loss (retransplantation, mortality), evolution of pulmonary function and functional exercise capacity were analyzed 7 years after inclusion of the last study subject. Following LTx, 22/43 (51%) patients of the placebo group and 11/40 (28%) patients of the azithromycin group ever developed CLAD (p = 0.043). CLAD-free survival was significantly longer in the azithromycin group (p = 0.024). No difference was present in proportion of obstructive versus restrictive CLAD between both groups. Graft loss was similar in both groups: 23/43 (53%) versus 16/40 (40%) patients (p = 0.27). Long-term pulmonary function and functional exercise capacity were significantly better in the azithromycin group (p < 0.05). Prophylactic azithromycin therapy reduces long-term CLAD prevalence and improves CLAD-free survival, pulmonary function, and functional exercise capacity after LTx.


Subject(s)
Antibiotic Prophylaxis , Azithromycin/therapeutic use , Bacteremia/drug therapy , Bronchiolitis Obliterans/surgery , Graft Rejection/drug therapy , Lung Transplantation/adverse effects , Anti-Bacterial Agents/therapeutic use , Bacteremia/microbiology , Bronchiolitis Obliterans/complications , Cohort Studies , Double-Blind Method , Female , Follow-Up Studies , Forced Expiratory Volume , Graft Rejection/etiology , Graft Rejection/pathology , Graft Survival , Humans , Male , Postoperative Complications , Prognosis , Risk Factors , Syndrome , Transplantation, Homologous
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