Following a lung transplant, chronic organ rejection remains the leading cause of long-term illness and death. Rejection is identified by progressive loss of lung function and progressive scarring around small air passageways. The term brochiolitis obliterans syndrome (BOS) is used to describe scarring in the absence of a biopsy.
Jonathan Orens, M.D., medical director of lung transplantation and associate professor of medicine at Hopkins, used the antibiotic azithromycin in six lung transplant recipients to treat BOS. Orens and fellow researchers discovered significant improvement in pulmonary function in five patients. The data now suggest this therapy in treating BOS. “We believe these results may have immediate clinical impact, since to date, no other pharmacologic agent has improved lung function in BOS,” says Orens.
Lung rejection following transplantation is currently a challenge for physicians. Although short-term survival is improved with a transplant, long-term survival is limited because BOS affects between 12-18 percent of lung transplant recipients at one year and up to 75 percent of individuals by five years. Nationally, the five-year survival rate following lung transplantation has remained at 45 percent, although Hopkins reports a 58 percent five-year survival rate post transplant.
“If not for this single important problem, the long-term survival after lung transplantation would be dramatically better,” claims Orens. “Chronic rejection is the Achilles’ heel of lung transplantation. We’ve got to figure this out or we will never improve the survival outcomes of lung transplantation.”
For more information about the azithromycin study, see Gerhardt, SG, McDyer, JF, Girgis, RE, Conte, JV, Yang, SC and Orens, JB. “Maintenance Azithromycin Therapy for Bronchiolitis Obliterans Syndrome: Results of a Pilot Study,” AJRCCM, Winter 2002. For information on HOPGENE, visit the Web site, www.hopgene.org.
Bridges Fall 2003
