PURPOSE: Prospectively examine the long term effect of low dose Azithromycin (Az) on progression of established Bronchiolitis Obliterance (BO) in lung transplant patients (LTx).
METHODS: Lung trnaplant patients with evidence of chronic rejection for at least 6 months were treated with a loading dose of Az (1 gram) followed by 250 mg PO three times a week. Chronic rejection was defined as a 20% drop in FEV1 from best post operative FEV1 after exclusion of other etiologies. Five data points were recorded for each patient, six month (M6), 3 months (M3) and time zero (0) prior to treatment initiation and 3 and 6 months post treatment initiation. statistical significance was done using ANOVA for repeated measures with specific comparisons.
RESULTS: Individual as well as mean FEV1 data are shown in Figure 1. Six patients (2 females & 4 males), mean age 57.8 yrs (range 42-65 yrs)were included in the study (4 double lung Tx and 2 single lung Tx; 4 patients had COPD, 1 Cystic fibrosis, 1 IPF).All patients were on steroids, calcineurin inhibitors, and cell cycle inhibitors. The time of Az initiation in relation to transplant was between 1 –10 years. Improvement in FEV1 was noticed in 2 patients (500 ml actual improvement in each ) which was sustained up to 6 months .Both patients were COPD who had an accelerated decline in FEV1 in the preceding 6 months prior to Az. There was no relation to transplant date in term of response. Stabilization was noticed in the remaining 4 patients. There were no reported side effects.
CONCLUSION: In this prospective study Az was effective in halting the progression of BO. The best response was observed in 2 patients with accelerated decline in FEV1. This could be the target group for a future randomized placebo controlled trial to confirm the benefit of this treatment.
CLINICAL IMPLICATIONS: Successful treatment of BO may have a significant impact on lung tramsplant survival as it is the main cause of long term mortality.
DISCLOSURE: Wael Batobara, None.