Prophylactic Azithromycin Therapy After Lung Transplantation: Post hoc Analysis of a Randomized Controlled Trial

• Published in: American journal of transplantation Vol. 16; no. 1; pp. 254 - 261
• Main Authors: Ruttens, D., Verleden, S. E., Vandermeulen, E., Bellon, H., Vanaudenaerde, B. M., Somers, J., Schoonis, A., Schaevers, V., Van Raemdonck, D. E., Neyrinck, A., Dupont, L. J., Yserbyt, J., Verleden, G. M., Vos, R.
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: (allograft) function/dysfunction; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Azithromycin - therapeutic use; Bacteremia - drug therapy; Bacteremia - microbiology; bronchiolitis obliterans (BOS); Bronchiolitis Obliterans - complications; Bronchiolitis Obliterans - surgery; clinical research/practice; Cohort Studies; Double-Blind Method; Female; Follow-Up Studies; Forced Expiratory Volume; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Rejection - pathology; Graft Survival; Humans; lung; lung failure/injury; Lung Transplantation - adverse effects; lung transplantation/pulmonology; Male; Postoperative Complications; preventive healthcare; Prognosis; rejection: chronic; Risk Factors; Syndrome; Transplantation, Homologous; lung; preventive healthcare; bronchiolitis obliterans (BOS); (allograft) function/dysfunction; clinical research/practice; lung transplantation/pulmonology; rejection: chronic; lung failure/injury
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13417

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. This post hoc analysis of a randomized controlled trial demonstrates improved chronic lung allograft dysfunction‐free survival, pulmonary function, and exercise capacity with prophylactic azithromycin therapy after lung transplantation.