title: Prophylactic Azithromycin Therapy After Lung Transplantation: Post hoc Analysis of a Randomized Controlled Trial.
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.
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Ruttens
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: S E
authors.initials: SE
authors.lastname: Verleden
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Vandermeulen
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Bellon
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: B M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.|Department of Thoracic Surgery, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Somers
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Schoonis
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Schaevers
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.|Department of Thoracic Surgery, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: D E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.|Department of Anesthesiology, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Neyrinck
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: L J
authors.initials: LJ
authors.lastname: Dupont
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Yserbyt
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: G M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: Lung Transplant Unit, Division of Respiratory Diseases, Department of Clinical and Experimental Medicine, KULeuven and UZ Leuven, Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Vos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D017963:Azithromycin / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome; D014184:Transplantation, Homologous
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: (allograft) function/dysfunction; bronchiolitis obliterans (BOS); clinical research/practice; lung; lung failure/injury; lung transplantation/pulmonology; preventive healthcare; rejection: chronic