Prophylactic azithromycin benefit lasts after lung transplant

(HealthDay)—For patients undergoing lung transplantation (LTx), prophylactic azithromycin is associated with reduced risk of chronic lung allograft dysfunction (CLAD), according to a study published online Aug. 4 in the American Journal of Transplantation.

Noting that prophylactic azithromycin has been shown to improve freedom from bronchiolitis obliterans syndrome two years after LTx, David Ruttens, from KU Leuven and UZ Leuven in Belgium, and colleagues re-evaluated the long-term effects of this approach. They conducted a retrospective, intention-to-treat analysis of a randomized controlled trial comparing prophylactic treatment with placebo (43 patients) versus azithromycin (40 patients) after LTx. Seven years after the inclusion of the last subject, they examined CLAD, graft loss (re-transplantation, mortality), evolution of pulmonary function, and functional exercise capacity.

The researchers found that 51 percent of the placebo group and 28 percent of the azithromycin group ever developed CLAD after LTx (P = 0.043). The azithromycin group had longer CLAD-free survival (P = 0.024). The proportion of patients with obstructive versus restrictive CLAD was similar between the groups. The groups had similar graft loss: 53 percent in the placebo group versus 40 percent in the azithromycin group (P = 0.27). The azithromycin group had better long-term pulmonary function and functional exercise capacity (P < 0.05).

"In summary, our long-term follow-up data support a sustained benefit of post-transplant, prophylactic azithromycin in prolonging CLAD-free survival and preserving allograft function and exercise capacity," the authors write.