General thoracic surgery
Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation

https://doi.org/10.1016/j.jtcvs.2011.04.028Get rights and content
Under an Elsevier user license
open archive

Objectives

Gastroesophageal reflux disease (GERD) is implicated as a risk factor for bronchiolitis obliterans syndrome after lung transplantation, but its effects on acute rejection, early allograft function, and survival are unclear. Therefore, we sought to systematically understand the time-related impact of pretransplant GERD on graft function (spirometry), mortality, and acute rejection early after lung transplantation.

Methods

From January 2005 to July 2008, 215 patients underwent lung transplantation; 114 had preoperative pH testing, and 32 (28%) had objective evidence of GERD. Lung function was assessed by forced 1-second expiratory volume (FEV1; percent of predicted) in 97 patients, mortality by follow-up (median, 2.2 years), and acute rejection by transbronchial biopsy.

Results

Pretransplant GERD was associated with decreased FEV1 early after lung transplantation (P = .01) such that by 18 months, FEV1 was 70% of predicted in double lung transplant patients with GERD versus 83% among non-GERD patients (P = .05). A similar decrease was observed in single lung transplantation (50% vs 60%, respectively; P = .09). GERD patients had lower survival early after transplant ( P = .02)—75% versus 90%. Presence of GERD did not affect acute rejection (P = .6).

Conclusions

For lung transplant recipients, pretransplant GERD is associated with worse early allograft function and survival, but not increased acute rejection. The compromise in lung function is substantial, such that FEV1 after double lung transplant in GERD patients approaches that of single lung transplant in non-GERD patients. We advocate thorough testing for GERD before lung transplantation; if identified, aggressive therapy early after transplant, including fundoplication, may prove efficacious.

CTSNet classification

12

Abbreviations and Acronyms

BOS
bronchiolitis obliterans syndrome
FEV1
forced 1-second expiratory volume
FEV1%
percent of predicted FEV1
GERD
gastroesophageal reflux disease

Cited by (0)

This study was supported in part by the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, James and Sharon Kennedy, the Slosburg Family Charitable Trust, and Stephen and Saundra Spencer (to G.P.B.), and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (to E.H.B.).

Disclosures: Authors have nothing to disclose with regard to commercial support.