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. 2010 May;29(5):531-7.
doi: 10.1016/j.healun.2009.12.003. Epub 2010 Feb 4.

Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome

Raksha Jain  1 , Ramsey R Hachem, Matthew R Morrell, Elbert P Trulock, Murali M Chakinala, Roger D Yusen, Howard J Huang, Thalachallour Mohanakumar, G Alexander Patterson, Michael J Walter
Affiliations

Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome

Raksha Jain et al. J Heart Lung Transplant. 2010 May.

Abstract

Background: Previous studies have suggested that azithromycin improves lung function in lung transplant recipients with bronchiolitis obliterans syndrome (BOS). However, these studies did not include a non-treated BOS control cohort or perform survival analysis. This study was undertaken to estimate the effect of azithromycin treatment on survival in lung transplant recipients with BOS.

Methods: We conducted a retrospective cohort study of consecutive lung transplant recipients who developed BOS between 1999 and 2007. An association between azithromycin treatment and death was assessed using univariate and multivariate time-dependent Cox regression analysis.

Results: Of the 178 recipients who developed BOS in our study, 78 did so after 2003 and were treated with azithromycin. The azithromycin-treated and untreated cohorts had similar baseline characteristics. Univariate analysis demonstrated that azithromycin treatment was associated with a survival advantage and this beneficial treatment effect was more pronounced when treatment was initiated during BOS Stage 1. Multivariate analysis demonstrated azithromycin treatment during BOS Stage 1 (adjusted hazard ratio = 0.23, p = 0.01) and absolute forced expiratory volume in 1 second (FEV(1)) at the time of BOS Stage 1 (adjusted hazard ratio = 0.52, p = 0.003) were both associated with a decreased risk of death.

Conclusions: In lung transplant recipients with BOS Stage 1, azithromycin treatment initiated before BOS Stage 2 was independently associated with a significant reduction in the risk of death. This finding supports the need for a randomized, controlled trial to confirm the impact of azithromycin on survival in lung transplant recipients.

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Conflict of interest statement

Conflict of Interest Statement

No authors involved in the preparation of this manuscript have any financial relationships with industry or other agencies related to azithromycin or other macrolide antibiotics.

Figures

Figure 1
Figure 1. Flowchart of lung transplant recipients with BOS treated with azithromycin
Between August 1 1998 and June 30, 2004, 297 patients underwent lung transplantation. During our follow-up through January 1, 2008, BOS stage 1 developed in 179. Of these 179 recipients, 95 who predominately developed BOS prior to 2003 were not prescribed azithromycin for treatment of BOS (No Azithromycin Cohort) and 78 who predominantly developed BOS after 2003 received azithromycin for treatment of BOS (Azithromycin Cohort).
See this image and copyright information in PMC

References

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