Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, WA, USA.
J Heart Lung Transplant. 2022 Jan;41(1):20-23. doi: 10.1016/j.healun.2021.10.008. Epub 2021 Oct 22.
Chronic lung allograft dysfunction (CLAD) is the most important long-term complication after lung transplant (LTx), and clinical experience suggests significant variability in its management. We sought to capture azithromycin practices among LTx providers internationally. A survey was distributed via the International Society for Heart and Lung Transplantation and completed by 103 respondents (15 countries). Azithromycin indications, timing, and dosing varied significantly, and 37 (36%) reported inconsistency even within their center. Thirty (29%) reported initiating azithromycin prophylactically (during initial transplant hospitalization). Of 73 others, only 10 (14%) reported waiting until CLAD diagnosis (with persistent ≥20% pulmonary function decline). Most initiated azithromycin after a CLAD risk-factor and/or event, including 59 (81%) for a persistent ≥10% decrement in FEV, 32 (44%) for lymphocytic bronchiolitis, and 27 (37%) for bronchoalveolar lavage neutrophilia. Azithromycin prescribing patterns appear to vary significantly, and further study is needed to elucidate the optimal timing and indications for its initiation after LTx.
慢性肺移植功能障碍（CLAD）是肺移植（LTx）后最重要的长期并发症，临床经验表明其治疗存在显著的变异性。我们试图了解国际 LTx 提供者中使用阿奇霉素的情况。一项调查通过国际心肺移植学会进行了分发，并由 103 名受访者（来自 15 个国家）完成。阿奇霉素的适应证、时机和剂量存在显著差异，37 名（36%）报告即使在其中心内也存在不一致性。30 名（29%）报告预防性使用阿奇霉素（在初始移植住院期间）。在其他 73 名患者中，只有 10 名（14%）报告等到 CLAD 诊断后（持续≥20%的肺功能下降）才开始使用阿奇霉素。大多数人在出现 CLAD 危险因素和/或事件后开始使用阿奇霉素，包括 59 名（81%）因 FEV 持续下降≥10%，32 名（44%）因淋巴细胞性细支气管炎，27 名（37%）因支气管肺泡灌洗中性粒细胞增多。阿奇霉素的处方模式似乎存在显著差异，需要进一步研究阐明其在 LTx 后开始使用的最佳时机和适应证。
