Prophylactic Azithromycin Therapy After Lung Transplantation: Post hoc Analysis of a Randomized Controlled Trial
Prophylactic Azithromycin Therapy After Lung Transplantation: Post hoc Analysis of a Randomized Controlled Trial
复制标题
DOI：
10.1111/ajt.13417
复制
发表时间：
2016-01-01
影响因子：
8.8
通讯作者：
Vos, R.
中科院分区：
文献类型：
--
作者：
Ruttens, D.;Verleden, S. E.;Vos, R.
已证实预防性阿奇霉素治疗可改善肺移植（LTx）后2年闭塞性细支气管炎综合征（BOS）的发生率。在当前的研究中，我们根据慢性肺移植物功能障碍（CLAD）的最新分类系统重新评估了这种预防方法的长期效果。对一项随机对照试验进行回顾性意向治疗分析，比较LTx后安慰剂（n = 43）与阿奇霉素（n = 40）的预防性治疗。在纳入最后一名研究受试者后7年，分析移植物功能障碍（CLAD）、移植物丢失（再次移植、死亡率）、肺功能和功能性运动能力的演变。LTx后，安慰剂组22/43（51%）例患者和阿奇霉素组11/40（28%）例患者发生CLAD（p = 0.043）。阿奇霉素组的无CLAD生存期显著延长（p = 0.024）。两组间阻塞性与限制性CLAD的比例无差异。两组的移植物丢失相似：23/43（53%）vs 16/40（40%）例患者（p = 0.27）。长期肺功能和功能性运动能力在阿奇霉素组明显更好（p < 0.05）。预防性阿奇霉素治疗可降低长期CLAD患病率，并改善LTx后无CLAD生存率、肺功能和功能性运动能力。
Prophylactic azithromycin treatment has been demonstrated to improve freedom from bronchiolitis obliterans syndrome (BOS) 2 years after lung transplantation (LTx). In the current study, we re-evaluated the long-term effects of this prophylactic approach in view of the updated classification system for chronic lung allograft dysfunction (CLAD). A retrospective, intention-to-treat analysis of a randomized controlled trial comparing prophylactic treatment with placebo (n = 43) versus azithromycin (n = 40) after LTx was performed. Graft dysfunction (CLAD), graft loss (retransplantation, mortality), evolution of pulmonary function and functional exercise capacity were analyzed 7 years after inclusion of the last study subject. Following LTx, 22/43 (51%) patients of the placebo group and 11/40 (28%) patients of the azithromycin group ever developed CLAD (p = 0.043). CLAD-free survival was significantly longer in the azithromycin group (p = 0.024). No difference was present in proportion of obstructive versus restrictive CLAD between both groups. Graft loss was similar in both groups: 23/43 (53%) versus 16/40 (40%) patients (p = 0.27). Long-term pulmonary function and functional exercise capacity were significantly better in the azithromycin group (p < 0.05). Prophylactic azithromycin therapy reduces long-term CLAD prevalence and improves CLAD-free survival, pulmonary function, and functional exercise capacity after LTx.