Clinical and immunological evaluation of 12-month azithromycin therapy in chronic lung allograft rejection

Meloni Federica, Solari Nadia, Morosini Monica, Cascina Alessandro, Oggionni Tiberio, Bini Francesco, Viganò Mario, Fietta Anna Maria

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Background: Bronchiolitis obliterans syndrome (BOS) is the leading cause of morbidity/mortality in lung-transplant recipients (LTRs). Recent studies demonstrated that azithromycin (AZI) can improve graft function in BOS. We here investigated whether a 12-month course of AZI could more efficiently impact the course of BOS if administered early in BOS development. Methods: Using a retrospective study, we examined AZI effects on graft function in 62 LTRs: 25 with potential BOS (BOS 0-p) and 37 with BOS grade 1-3. Response was defined as a≥10% FEV 1 increase. Bronchoalveolar (BAL) neutrophilia and levels of IL-8, 8-isoprostane and other plasma cytokines were analyzed as parameters of lung or systemic inflammation. Results: After 12-month AZI, 13 patients were responders, 35 had graft function stabilization, and 14 further deteriorated. The frequency of responders was significantly higher in LTRs with BOS 0-p (44%) than in those with BOS grade 1-3 (6%). No association was found between BAL features and AZI response while a significant decrease in plasma levels of IL-8, MCP-1, I-309, MIP-1α, and TNF-α was detected. Conclusions: Long-term AZI can improve or stabilize lung graft function in LTRs with BOS, but the treatment impacts the course of the disease more efficiently if administered in BOS 0-p.

Original languageEnglish
JournalClinical Transplantation
Issue number4
Publication statusPublished - Jul 2011


  • Azithromycin
  • Bronchiolitis obliterans syndrome
  • Clinical effect
  • Immunological effect
  • Lung transplant

ASJC Scopus subject areas

  • Transplantation


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