A Prospective Pilot-Study of Azithromycin for Lymphocytic Airway Inflammation after Lung Transplantation

Abstract

Purpose Lymphocytic airway inflammation, the pathological correlate of acute airway rejection, is an important risk factor for later chronic lung allograft rejection. We hypothesized that azithromycin (AZI) could control lymphocytic airway inflammation. Methods and Materials Fifteen double-lung transplant recipients with allograft dysfunction due to lymphocytic airway inflammation were prospectively treated with AZI for 3 months. Airflow measurements (FVC, FEV 1, FEF25-75 and Tiffeneau) and FeNO were assessed before, during and up to 6 months after the start of AZI. Local inflammation, assessed on airway biopsy (‘B-grade’) and in broncho-alveolar lavage fluid (IL-6 and IL-8 protein levels, cell total and differential counts) as well as systemic inflammation (C-reactive protein) were compared between baseline and after 3 months of treatment. Results Following initiation of AZI, airflow returned to baseline levels as soon as after 1 month and further improved thereafter. FeNO decreased to baseline ( Figure 1 ). After 3 months of treatment, histologic lymphocytic airway inflammation and IL-8 levels, total and differential total cell counts (macrophages, neutrophils and eosinophils) as well as CRP significantly decreased compared to baseline ( Table 1 ). Conclusions AZI is beneficial in controlling post-transplant lymphocytic airway inflammation. Trial Registration NCT01109160 (AZI002). [ figure 1 ] [ figure 2 ]