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

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 BUS 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 I. Multivariate analysis demonstrated azithromycin treatment during BOS Stage I (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 BUS 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. J Heart Lung Transplant 2010;29:531-537 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.