Open AccessDornase alfa during lower respiratory tract infection post‐lung transplantation: a randomized controlled trial
Author(s) -
Tarrant Benjamin James,
Snell Gregory,
Ivulich Steven,
Button Brenda,
Thompson Bruce,
Holland Anne
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13400
Subject(s) - medicine , sputum , lung transplantation , randomized controlled trial , lower respiratory tract infection , spirometry , adverse effect , transplantation , respiratory tract infections , respiratory system , asthma , tuberculosis , pathology
Summary Lung transplant ( LT x) recipients are at risk of lower respiratory tract infection ( LRTI ), while altered physiology may lead to difficulty clearing sputum. Mucoactive agents alter sputum properties and facilitate mucociliary clearance; however, there are no randomized controlled trials ( RCT s) studying this post‐ LT x. This RCT evaluated the safety and efficacy of nebulized dornase alfa during LRTI post‐ LT x. Inpatient adults with LRTI and abnormal sputum following bilateral sequential LT x were eligible. Participants received 5 ml of isotonic saline, or 2.5 ml of dornase alfa, nebulized once daily for 1 month followed by 2 months symptom diary. Primary outcome was lung clearance index ( LCI 2%). Secondary outcomes included spirometry, quality of life, readmission, length of stay, self‐reported exacerbations, and adverse events at baseline, 1 and 3 months. Thirty‐two participated, 16 in each group, baseline mean ( SD ) FEV 1 % 58 (22), median ( IQR ) length of stay 7 (5) days, time since LT x 3.49 (6.80) years. There were no significant between‐group differences in LCI 2% at any point (1 month mean difference −0.34, 95% confidence interval ( CI ) −1.57 to 0.89; 3 months −0.76, 95% CI −2.29 to 0.78, favoring dornase alfa). Secondary outcomes were not different between groups. These results do not support the routine use of dornase alfa during LRTI in LT x recipients.