title: Bile acids aspiration reduces survival in lung transplant recipients with BOS despite azithromycin.
abstract: Azithromycin (AZM) improved bronchiolitis obliterans syndrome (BOS) and reduced aspiration in lung transplant (LTx) recipients. We hypothesize that AZM could improve graft and overall survival more efficiently in LTx patients with BOS who have bile acid (BA) aspiration by protecting against the aspiration-induced progression of BOS. The goal was to compare FEV(1) (% baseline), BOS progression and overall survival in LTx recipients treated with AZM for BOS, both with versus without BA aspiration. Therefore, LTx recipients treated with AZM for BOS were recruited and broncho-alveolar lavage (BAL) samples were analyzed for the presence of BA and neutrophilia before the start of AZM treatment. Short-term effect of AZM on FEV(1) and BAL neutrophilia was assessed, progression of BOS and survival were followed-up for 3 years and results were compared between patients with/without BA aspiration. 19/37 LTx patients had BA in BAL. BA aspiration predisposed to a significantly worse outcome, in terms of decline in FEV(1) , progression of BOS ≥ 1 and survival. AZM does not seem to protect against the long-term allograft dysfunction caused by gastroesophageal reflux (GER) and aspiration and an additional treatment targeting aspiration may be indicated in those LTx patients.
authors.affiliation: Center for Gastroenterological Research, KULeuven, Belgium Laboratory of Pneumology, KULeuven, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Mertens
authors.forename: K
authors.initials: K
authors.lastname: Blondeau
authors.forename: L
authors.initials: L
authors.lastname: Van Oudenhove
authors.forename: B
authors.initials: B
authors.lastname: Vanaudenaerde
authors.forename: R
authors.initials: R
authors.lastname: Vos
authors.forename: R
authors.initials: R
authors.lastname: Farre
authors.forename: A
authors.initials: A
authors.lastname: Pauwels
authors.forename: G
authors.initials: G
authors.lastname: Verleden
authors.forename: D
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: D
authors.initials: D
authors.lastname: Sifrim
authors.forename: L J
authors.initials: LJ
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use*; D001647:Bile Acids and Salts / Q000032:analysis / Q000502:physiology*; D001989:Bronchiolitis Obliterans / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D053120:Respiratory Aspiration / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D001647:Bile Acids and Salts; D017963:Azithromycin