Effects of Azithromycin in Lung Transplant Recipients

Abstract

<h3>Purpose</h3> Current evidence for azithromycin (AZM) after lung transplantation (LuTx) covers both prophylactic use to prevent BOS and treatment after the occurrence of CLAD. We hereby report the effects of AZM in our cohort of LuTx patients. <h3>Methods</h3> This was a retrospective study including all adult patients who underwent LuTx from January 2004 to June 2019 and received long term AZM (250/500 mg p.o. 3 times a week) at any time after LuTx. Effects of AZM were evaluated with BAL analysis and pulmonary function tests. Patients were considered "responders" in case of a FEV1 increase > 10% after 3 and 6 months of treatment. <h3>Results</h3> 116 patients (out of 322 LuTx) received long term AZM after LuTx for five main reasons: 56 (48.3%) for BAL neutrophilia; 12 (10.3%) for recurrent respiratory infections; 16 (13.8%) for persistent mild acute rejection; 31 (26.7%) for CLAD onset and 1 (0.9%) as a prokinetic medication. Median FEV1 improvement in the first 3 months of treatment was 20 (-36; +80) mL/month in the whole cohort; AZM responders (85 individuals) showed a 23 (13; 86) mL/month FEV1 increase, while non responders experienced a FEV1 decline of 15 (-33; -8) mL/month. Results regarding BAL neutrophilia and survival can be found respectively in Figure 1 and 2.AZM was discontinued in 9 patients for adverse events: 4 gastrointestinal intolerance; 2 NTM isolated on sputum; 2 asymptomatic QTc lengthening; 1 malaise. <h3>Conclusion</h3> Azithromycin seems to be effective in improving lung graft function, especially in those who were administered it for BAL neutrophilia and frequent respiratory infections. In these subjects, CLAD free survival was also increased. Neutrophils count on BAL was decreased in all the cohort.