2006 - UZ Leuven

Bronchiolitis obliterans syndrome (BOS) remains the most importantcause of late mortality after lung transplantation (LTx). Treatment isdifficult, although recently azithromycin (azi) has been shown to havea beneficial effect in about 45% of patients. It is not known at thepresent time which patients have the most chance to benefit from thistreatment. Therefore, in this study we investigated the characteristicsof patients with BOS before starting treatment with azi and comparedthese parameters between responders (> 10% increase in FEVI) andnon-responders (no increase in FEVI). Fourteen patients wereincluded, with a mean age of 47 (13) y at the time of Ltx. There initialBOS stages were: 0-p(3), 1 (10), 2 (1). After 3 months of azi the meanFEVI (SD) increased from 2.40 (0.82) to 2.67 (0.85) (p=0.014). Therewere 6 responders (R) and 8 non-responders (NR). The FEVI in groupR increased from 2.11 (0.54)L to 2.75 (0.74)L (p = 0.016), whereas inthe NR group there was no change. The characteristics of both groupsat inclusion are summarized in the table. In conclusion: the onlysignificant different parameter discriminating between the R and NRgroup seems to be the % neutrophils in the BAL fluid. In fact, a BALneutrophilia of > 15% has a positive predictive value of 85% for asignificant FEVI response to azi, whereas a BAL neutrophilia of < 15%confers no effect at all (negative predictive value 100%).Characteristics at inclusionAgeSex (M/F)Type of LtxFK/CyAPOD azi startPre azi FEV1Pre Ltx diseaseBAL Pseudomonas% BAL neutrophiliaResponders(n = 6)48.8 (15)4/24SS/2SLtx5/1438 (493)2.20 (0.56)L2E/3F/1CF269.6 (24.3)Non-responders(n = 8)46.3 (12.5)5/36SS/1S/IHLTx8/01309 (942)2.50 (1.03) L4E/1F/2CF/1PPH29.2 (12.4)p-valueNSNSNSNS0.06NSNSNS0.0013117