Abstract
Introduction: Gastroesophageal reflux disease (GERD) after lung transplantation (LT) is associated with chronic lung allograft dysfunction (CLAD). Anti reflux surgery (ARS) in LT need to be evaluated.
Objective: To describe GERD occurrence in LT recipients and evaluate theeffect of ARS on lung allograft function.
Material and Methods: We retrospectively reviewed charts of 284 LT patients who had esophageal pH monitoring between 1991 and 2014. GERD was defined as a deMeester score>14.7. For patients who underwent ARS (fundoplication), the incidence of acute rejections (AR) and respiratory infections (RI) were compared before and after surgery. At 6 months post-ARS FEV1 were considered either improved (>110% from baseline), stabilized (91-109%) or deteriorated (<90%). Result are shown as median[IQR25-75] or mean±SD.
Results: GERD was present in 199/284 patients (70%) who underwent testing at 4.5 months [3.1; 9.6] after LT. In the GERD group, the deMeester score was 44±29.
GERD was more frequent in the cystic fibrosis patients (81%, vs 55% p<0.001) 59 patients (30%) underwent ARS 20 [13; 43] months after LT. Post-ARS, there was a decrease in AR from 1.04±0.98 to 0.42±0.99 episodes/year (p=0.001) and RI from 0.75±1.04 to 0.33±0.6 episodes/year (p=0.007). At 6 months, FEV1 improved in 37%, stabilized in 44%, and deteriorated in 17% of patients who had ARS.The number of patients with CLAD grading BOS≥0p decreased significantly from 51 (86.4%, pre-ARS) to 28 (47.4%, post-ARS) (n=59, p<0,0001).
Conclusion: Anti-reflux surgery for well chosen patients results in a decrease of AR, IR, and an improvement in pulmonary function.
- Copyright ©ERS 2015
