Clinical and immunological evaluation of 12‐month azithromycin therapy in chronic lung allograft rejection

Federica M, Nadia S, Monica M, Alessandro C, Tiberio O, Francesco B, Mario V, Maria FA. Clinical and immunological evaluation of 12‐month azithromycin therapy in chronic lung allograft rejection.
Clin Transplant 2011: 25: E381–E389. © 2011 John Wiley & Sons A/S.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% FEV1 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.