Center for Gastroenterological Research, KULeuven, Belgium Laboratory of Pneumology, KULeuven, Belgium.
Am J Transplant. 2011 Feb;11(2):329-35. doi: 10.1111/j.1600-6143.2010.03380.x.
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.
阿奇霉素（AZM）可改善支气管闭塞性细支气管炎综合征（BOS）并减少肺移植（LTx）受者的吸入。我们假设 AZM 通过防止吸入引起的 BOS 进展，可更有效地改善患有胆汁酸（BA）吸入的 BOS 患者的移植物和总生存率。目的是比较接受 AZM 治疗 BOS 的 LTx 受者的 FEV1（%基线）、BOS 进展和总生存率，以及是否存在 BA 吸入。因此，招募了接受 AZM 治疗 BOS 的 LTx 受者，并在开始 AZM 治疗之前分析支气管肺泡灌洗（BAL）样本中是否存在 BA 和中性粒细胞增多。评估 AZM 对 FEV1 和 BAL 中性粒细胞增多的短期影响，随访 BOS 进展和 3 年生存率，并比较 BA 吸入患者和无 BA 吸入患者的结果。19/37 例 LTx 患者 BAL 中有 BA。BA 吸入易导致 FEV1 下降、BOS 进展≥1 和生存率显著降低等不良后果。AZM 似乎不能预防胃食管反流（GER）和吸入引起的长期移植物功能障碍，可能需要针对吸入的额外治疗。
