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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11602

Title: A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation
Authors: Vos, R.
Vanaudenaerde, B. M.
Verleden, S. E.
De Vleeschauwer, S. I.
Willems-Widyastuti, A.
Van Raemdonck, D. E.
Schoonis, A.
Dupont, L. J.
Verleden, G. M.
Issue Date: 2011
Citation: EUROPEAN RESPIRATORY JOURNAL, 37 (1). p. 164-172
Abstract: Azithromycin reduces airway inflammation and improves forced expiratory volume in 1 s (FEV1) in chronic rejection or bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Azithromycin prophylaxis might prevent BOS. A double-blind randomised controlled trial of azithromycin (n=40) or placebo (n=43), initiated at discharge and administered three times a week for 2 yrs, was performed in 2005-2009 at the Leuven University Hospital (Leuven, Belgium). Primary end-points were BOS-free and overall survival 2 yrs after LTx; secondary end-points were acute rejection, lymphocytic bronchiolitis and pneumonitis rate, prevalence of pseudomonal airway colonisation or gastro-oesophageal reflux, and change in FEV1, airway and systemic inflammation over time. Patients developing BOS were assessed for change in FEV1 with open-label azithromycin. BOS occurred less in patients receiving azithromycin: 12.5 versus 44.2% (p=0.0017). BOS-free survival was better with azithromycin (hazard ratio 0.27, 95% CI 0.092-0.816; p=0.020). Overall survival, acute rejection, lymphocytic bronchiolitis, pneumonitis, colonisation and reflux were comparable between groups. Patients receiving azithromycin demonstrated better FEV1 (p=0.028), and lower airway neutrophilia (p=0.015) and systemic C-reactive protein levels (p=0.050) over time. Open-label azithromycin for BOS improved FEV1 in 52.2% patients. No serious adverse events were noted. Azithromycin prophylaxis attenuates local and systemic inflammation, improves FEV1 and reduces BOS 2 yrs after LTx.
Notes: [Verleden, G. M.] Univ Hosp Gasthuisberg, Lung Transplantat Unit, B-3000 Louvain, Belgium. [Vos, R.; Vanaudenaerde, B. M.; Verleden, S. E.; De Vleeschauwer, S. I.; Willems-Widyastuti, A.] Katholieke Univ Leuven, Lab Pneumol, Leuven, Belgium. [Vos, R.; Vanaudenaerde, B. M.; Verleden, S. E.; De Vleeschauwer, S. I.; Willems-Widyastuti, A.; Van Raemdonck, D. E.; Schoonis, A.; Dupont, L. J.; Verleden, G. M.] Katholieke Univ Leuven, Lung Transplantat Unit, Leuven, Belgium. [Van Raemdonck, D. E.] Katholieke Univ Leuven, Lab Expt Thorac Surg, Leuven, Belgium. [Nawrot, T. S.] Katholieke Univ Leuven, Sch Publ Hlth, Unit Lung Toxicol Occupat & Environm Med, Leuven, Belgium. [Nawrot, T. S.] Univ Hasselt, Ctr Environm Sci, Diepenbeek, Belgium. geert.verleden@uz.kuleuven.be
URI: http://hdl.handle.net/1942/11602
DOI: 10.1183/09031936.00068310
ISI #: 000285752400025
ISSN: 0903-1936
Category: A1
Type: Journal Contribution
Validation: ecoom, 2012
Appears in Collections: Research publications

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