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

Raksha Jain, 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

Research output: Contribution to journalArticle

88 Scopus citations

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 (FEV1) 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.

Original languageEnglish (US)
Pages (from-to)531-537
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume29
Issue number5
DOIs
StatePublished - May 1 2010

Keywords

  • azithromycin
  • bronchiolitis
  • chronic rejection
  • lung transplant
  • macrolides
  • survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Jain, R., Hachem, R. R., Morrell, M. R., Trulock, E. P., Chakinala, M. M., Yusen, R. D., Huang, H. J., Mohanakumar, T., Patterson, G. A., & Walter, M. J. (2010). Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome. Journal of Heart and Lung Transplantation, 29(5), 531-537. https://doi.org/10.1016/j.healun.2009.12.003