title: Clinical and immunological evaluation of 12-month azithromycin therapy in chronic lung allograft rejection.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is the leading cause of morbidity/mortality in lung-transplant recipients (LTRs). Recent studies demonstrated that azithromycin (AZI) can improve graft function in BOS. We here investigated whether a 12-month course of AZI could more efficiently impact the course of BOS if administered early in BOS development.
  
  
  METHODS
  Using a retrospective study, we examined AZI effects on graft function in 62 LTRs: 25 with potential BOS (BOS 0-p) and 37 with BOS grade 1-3. Response was defined as a ≥ 10% FEV(1) increase. Bronchoalveolar (BAL) neutrophilia and levels of IL-8, 8-isoprostane and other plasma cytokines were analyzed as parameters of lung or systemic inflammation.
  
  
  RESULTS
  After 12-month AZI, 13 patients were responders, 35 had graft function stabilization, and 14 further deteriorated. The frequency of responders was significantly higher in LTRs with BOS 0-p (44%) than in those with BOS grade 1-3 (6%). No association was found between BAL features and AZI response while a significant decrease in plasma levels of IL-8, MCP-1, I-309, MIP-1α, and TNF-α was detected.
  
  
  CONCLUSIONS
  Long-term AZI can improve or stabilize lung graft function in LTRs with BOS, but the treatment impacts the course of the disease more efficiently if administered in BOS 0-p.
authors.affiliation: Department of Hematological, Pneumological and Cardiovascular Sciences, University of Pavia School of Medicine & IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
authors.forename: Meloni
authors.initials: M
authors.lastname: Federica
authors.forename: Solari
authors.initials: S
authors.lastname: Nadia
authors.forename: Morosini
authors.initials: M
authors.lastname: Monica
authors.forename: Cascina
authors.initials: C
authors.lastname: Alessandro
authors.forename: Oggionni
authors.initials: O
authors.lastname: Tiberio
authors.forename: Bini
authors.initials: B
authors.lastname: Francesco
authors.forename: Viganò
authors.initials: V
authors.lastname: Mario
authors.forename: Fietta Anna
authors.initials: FA
authors.lastname: Maria
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000628:therapy*; D054405:Chemokine CCL3 / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016209:Interleukin-8 / Q000378:metabolism; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D054405:Chemokine CCL3; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D017963:Azithromycin