AZITHROMYCIN PROPHYLAXIS AFTER LUNG TRANSPLANT IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL

ABSTRACT Background Azithromycin prophylaxis (AP) in lung transplant recipients has been shown to reduce the composite endpoint of death or chronic lung allograft dysfunction (CLAD) onset but without a clear effect on overall survival. Our program began using AP in 2010. We sought to evaluate the association between AP and survival, the risk of CLAD and baseline lung allograft dysfunction (BLAD). Methods We studied double lung recipients transplanted between 2004-2016. We defined AP as chronic use of azithromycin initiated prior to CLAD onset. We analyzed the association between AP and death or retransplant using Cox regression with adjustment for potential confounders. We further used Cox and logistic models to assess the relationship between AP and post-transplant CLAD onset and BLAD respectively. Results 445 patients were included and 344 (77%) received AP [median time from transplant 51 days]. Patients receiving AP were more likely to receive induction with IL-2 receptor antagonists (57% vs. 35%; p Conclusions Azithromycin prophylaxis is associated with improved survival after lung transplantation, potentially through improved baseline function. These findings build on prior trial results and suggest AP is beneficial for lung transplant recipients.