1. Bile acids aspiration reduces survival in lung transplant recipients with BOS despite azithromycin.
- Author
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Mertens V, Blondeau K, Van Oudenhove L, Vanaudenaerde B, Vos R, Farre R, Pauwels A, Verleden G, Van Raemdonck D, Sifrim D, and Dupont LJ
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Bile Acids and Salts analysis, Bronchiolitis Obliterans physiopathology, Bronchoalveolar Lavage Fluid chemistry, Bronchoalveolar Lavage Fluid cytology, Cohort Studies, Disease Progression, Female, Forced Expiratory Volume, Gastroesophageal Reflux drug therapy, Gastroesophageal Reflux etiology, Gastroesophageal Reflux physiopathology, Humans, Kaplan-Meier Estimate, Lung Transplantation mortality, Lung Transplantation pathology, Lung Transplantation physiology, Male, Middle Aged, Neutrophils pathology, Respiratory Aspiration physiopathology, Azithromycin therapeutic use, Bile Acids and Salts physiology, Bronchiolitis Obliterans drug therapy, Bronchiolitis Obliterans etiology, Lung Transplantation adverse effects, Respiratory Aspiration drug therapy, Respiratory Aspiration etiology
- Abstract
Azithromycin (AZM) improved bronchiolitis obliterans syndrome (BOS) and reduced aspiration in lung transplant (LTx) recipients. We hypothesize that AZM could improve graft and overall survival more efficiently in LTx patients with BOS who have bile acid (BA) aspiration by protecting against the aspiration-induced progression of BOS. The goal was to compare FEV(1) (% baseline), BOS progression and overall survival in LTx recipients treated with AZM for BOS, both with versus without BA aspiration. Therefore, LTx recipients treated with AZM for BOS were recruited and broncho-alveolar lavage (BAL) samples were analyzed for the presence of BA and neutrophilia before the start of AZM treatment. Short-term effect of AZM on FEV(1) and BAL neutrophilia was assessed, progression of BOS and survival were followed-up for 3 years and results were compared between patients with/without BA aspiration. 19/37 LTx patients had BA in BAL. BA aspiration predisposed to a significantly worse outcome, in terms of decline in FEV(1) , progression of BOS ≥ 1 and survival. AZM does not seem to protect against the long-term allograft dysfunction caused by gastroesophageal reflux (GER) and aspiration and an additional treatment targeting aspiration may be indicated in those LTx patients., (©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2011
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