Cristeto Porras Marta, Mora Cuesta Víctor Manuel, Iturbe Fernández David, Tello Mena Sandra, Alonso Lecue Pilar, Sánchez Moreno Laura, Miñambres García Eduardo, Naranjo Gozalo Sara, Izquierdo Cuervo Sheila, Cifrián Martínez José Manuel
Respiratory Department, Marqués de Valdecilla University Hospital, Santander, Spain.
Valdecilla Research Institute (IDIVAL), Santander, Spain.
Clin Transplant. 2023 Jan;37(1):e14832. doi: 10.1111/ctr.14832. Epub 2022 Oct 26.
Azithromycin (AZI) may be an effective immune modulator in lung transplant (LT) recipients, and can decrease chronic lung allograft dysfunction (CLAD) rates, the leading cause of mortality after the 1st year post-LT. The aim of the study is to assess the effect of AZI initiation and its timing on the incidence and severity of CLAD in LT recipients.
Single-center retrospective study, including LT recipients from 01/01/2011 to 30/06/2020. Four groups were established: those who started AZI at the 3rd week post-LT (group A), those who received AZI later than the 3rd week post-LT and had preserved FEV1 (B), those who did not receive AZI (C) and those who started AZI due to a decline in FEV1 (D). The dosage of AZI prescribed was 250 mg three times per week. CLAD was defined and graduated according to the 2019 ISHLT criteria.
We included 358 LT recipients: 139 (38.83%) were in group A, 94 (26.25%) in group B, 91 (25.42%) in group C, and 34 (9.50%) in group D. Group A experienced the lowest CLAD incidence and severity at 1 (p = .01), 3 (p < .001), and 5 years post-LT, followed by Group B. Groups C and D experienced a higher incidence and severity of CLAD (p = .015). Initiation of AZI prior to FEV1 decline (Groups A and B) proved to be protective against CLAD after adjusting for differences between the treatment groups.
Early initiation of AZI in LT recipients could have a role in decreasing the incidence and severity of CLAD. In addition, as long as FEV1 is preserved, initiating AZI at any time could also be useful to prevent the incidence of CLAD and reduce its severity.
阿奇霉素（AZI）可能是肺移植（LT）受者有效的免疫调节剂，可降低慢性肺移植功能障碍（CLAD）的发生率，CLAD是LT术后第1年死亡的主要原因。本研究旨在评估AZI起始使用及其时机对LT受者CLAD发生率和严重程度的影响。
单中心回顾性研究，纳入2011年1月1日至2020年6月30日的LT受者。分为四组：LT术后第3周开始使用AZI的患者（A组），LT术后第3周后开始使用AZI且FEV1保留的患者（B组），未接受AZI的患者（C组），以及因FEV1下降而开始使用AZI的患者（D组）。规定的AZI剂量为每周三次，每次250mg。CLAD根据2019年国际心脏和肺移植学会（ISHLT）标准进行定义和分级。
共纳入358例LT受者：A组139例（38.83%），B组94例（26.25%），C组91例（25.42%），D组34例（9.50%）。A组在LT术后1年（p = 0.01）、3年（p < 0.001）和5年时CLAD发生率和严重程度最低，其次是B组。C组和D组CLAD的发生率和严重程度更高（p = 0.015）。在调整治疗组之间的差异后，在FEV1下降之前开始使用AZI（A组和B组）被证明对CLAD有保护作用。
LT受者早期开始使用AZI可能有助于降低CLAD的发生率和严重程度。此外，只要FEV1保留，在任何时候开始使用AZI也可能有助于预防CLAD的发生并降低其严重程度。
