title: Clarithromycin for prevention of bronchiolitis obliterans syndrome in lung allograft recipients.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is the major limitation to long-term survival following lung transplantation and strategies to reduce its incidence have remained elusive. Macrolides may stabilize lung function in patients with established BOS. Their role, however, in prevention of BOS remains unexamined.
  
  
  METHODS
  Survival and BOS-free survival of 102 lung allograft recipients (LARs), transplanted at a single center between July 1995 and December 2001 who routinely received clarithromycin, were compared with two different control groups. The first control group consisted of 44 LARs from the same center who were transplanted from January 2002 onwards and did not receive clarithromycin. The second control group consisted of a contemporaneous cohort of 5089 recipients, transplanted between 1995 and 2001, reported to the United Network for Organ Sharing database.
  
  
  RESULTS
  When compared with the first control group, BOS-free survival was reduced in LARs receiving clarithromycin. Univariate (hazard ratio [HR] 3.13, p-value = 0.004) and multivariate (HR 3.49, p-value = 0.04) analyses showed that routine use of clarithromycin was associated with an increased risk of developing BOS. When compared with the second control group, the five-yr survival of clarithromycin group was similar (p-value = 0.24).
  
  
  CONCLUSIONS
  Routine use of clarithromycin does not delay development of BOS or improve survival.
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA. gdhillon@stanford.edu
authors.forename: Gundeep S
authors.initials: GS
authors.lastname: Dhillon
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Valentine
authors.forename: Joseph
authors.initials: J
authors.lastname: Levitt
authors.forename: Premal
authors.initials: P
authors.lastname: Patel
authors.forename: Meera R
authors.initials: MR
authors.lastname: Gupta
authors.forename: Steven R
authors.initials: SR
authors.lastname: Duncan
authors.forename: Leonardo
authors.initials: L
authors.lastname: Seoane
authors.forename: David
authors.initials: D
authors.lastname: Weill
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D017291:Clarithromycin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D013577:Syndrome; D014184:Transplantation, Homologous
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin