How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?

Pegna, Victoria; Mickevičius, Antanas; Tsang, Clement

doi:10.1016/j.medici.2014.11.006

Cited by 9 publications

(6 citation statements)

References 22 publications

(19 reference statements)

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“…8 However, our findings help explain why “not all” studies have shown that (i) distal reflux and BALF pepsin/bile acid concentrations correlate with lung function, 1 (ii) distal reflux correlates with BALF pepsin concentration, and is associated with a quicker progression to BOS 5 and (iii) fundoplication is associated with improved lung function. 30 Those patients that do respond well to fundoplication are likely those in whom GERD is an important mechanism for rejection but currently there are no comprehensive sham/placebo-controlled data (e.g., pre- and post-transplant esophageal body and LES/UES motility, using CC, impedance/pH data, BALF pepsin levels, and effect of surgery/type of surgery; oropharyngeal function etc.) available to formally explore which patients best benefit from fundoplication.…”

Section: Discussionmentioning

confidence: 99%

Impaired Esophageal Motility and Clearance Post-Lung Transplant: Risk For Chronic Allograft Failure

Tangaroonsanti

Lee

Crowell

et al. 2017

Clinical and Translational Gastroenterology

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Objectives:Gastroesophageal reflux is common in patients post-lung transplantation (LTx) and thus considered a risk factor for aspiration and consequently allograft rejection and the development of chronic allograft failure. However, evidence supporting this remains unclear and often contradictory. Our aim was to examine the role played by esophageal motility on gastroesophageal reflux exposure, along with its clearance and that of boluses swallowed, and the relationship to development of obstructive chronic lung allograft dysfunction (o-CLAD).Methods:Patients post-LTx (n=50, 26 female; mean age 55 years (range, 20–73 years)) completed high-resolution impedance manometry and 24-h pH/impedance. Esophageal motility abnormalities were classified based upon the Chicago Classification version 3.0.Results:Esophagogastric junction outflow obstruction alone (EGJOOa) (P=0.01), incomplete bolus transit (IBT) (P=0.006) and proximal reflux (P=0.042) increased the risk for o-CLAD. Patients with EGJOOa were most likely to present with o-CLAD (77%); despite being less likely to exhibit abnormal numbers of reflux events (10%) compared with those with normal motility (o-CLAD: 29%, P<0.05; abnormal reflux events: 64%, P<0.05). Patients with EGJOOa had lower total reflux bolus exposure time than those with normal motility (0.6 vs. 1.5% P<0.05). In addition, poor esophageal clearance documented by abnormal post-reflux swallow-induced peristaltic wave index associated with o-CLAD; inversely correlating with the proportion of reflux events reaching the proximal esophagus (r=−0.251; P=0.052).Conclusions:These observations support esophageal dysmotility, especially EGJOOa, and impaired clearance of swallowed bolus or refluxed contents, more so than just the presence of gastroesophageal reflux alone, as important risk factors in the development of o-CLAD.

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Section: Discussionmentioning

confidence: 99%

Impaired Esophageal Motility and Clearance Post-Lung Transplant: Risk For Chronic Allograft Failure

Tangaroonsanti

Lee

Crowell

et al. 2017

Clinical and Translational Gastroenterology

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“…The second most common indication of readmission of LT recipients was intractable nausea, which was also the most common cause of readmission of NT controls. Similarly, others have reported post-LARS intractable nausea or bloating requiring readmission (up to 22%), recurrence of GERD symptoms (up to 11%), and significant weight loss in LT recipients [5,6,22,23]. However, nausea or rectal flatulence, inability to belch or vomit, and dysphagia are well-described sequelae of LARS in the nontransplant population [9,17].…”

Section: Discussionmentioning

confidence: 84%

“…Similar to our experience, Davis et al [ 21 ] also did not find any difference in estimated blood loss, duration of surgery, or length of stay between 25 LT recipients and 23 NT controls. An additional handful of small, non-comparative studies of safety outcomes of LARS in LT recipients have reported satisfactory resolution of reflux symptoms after LARS [ 5 , 22 , 23 , 25 ]. We have also demonstrated excellent control of GERD after LARS in LT recipients with objective measures such as a pH study.…”

Section: Discussionmentioning

confidence: 99%

Morbidity of antireflux surgery in lung transplant and matched nontransplant cohorts is comparable

et al. 2022

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Background Safety data on perioperative outcomes of laparoscopic antireflux surgery (LARS) after lung transplantation (LT) are lacking. We compared the 30-day readmission rate and short-term morbidity after LARS between LT recipients and matched nontransplant (NT) controls. Methods Adult patients who underwent LARS between January 1, 2015, and October 31, 2021, were included. The participants were divided into two groups: LT recipients and NT controls. First, we compared 30-day readmission rates after LARS between the LT and NT cohorts. Next, we compared 30-day morbidity after LARS between the LT cohort and a 1-to-2 propensity score-matched NT cohort. Results A total of 1328 patients (55 LT recipients and 1273 NT controls) were included. The post-LARS 30-day readmission rate was higher in LT recipients than in the overall NT controls (14.5% vs. 2.8%, p < 0.001). Compared to matched NT controls, LT recipients had a lower prevalence of paraesophageal hernia, a smaller median hernia size, and higher peristaltic vigor. Also compared to the matched NT controls, the LT recipients had a lower median operative time but a longer median length of hospital stay. The proportion of patients with a post-LARS event within 30 postoperative days was comparable between the LT and matched NT cohorts (21.8% vs 14.5%, p = 0.24). Conclusions Despite a higher perceived risk of comorbidity burden, LT recipients and matched NT controls had similar rates of post-LARS 30-day morbidity at our large-volume center with expertise in transplant and foregut surgery. LARS after LT is safe. Graphical abstract

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“…ARS appears to resolve subjective symptoms of GERD in all studies that explored this as an outcome measure (16)(17)(18)(19)32). Only two study performed objective assessment of GERD in a half of their post-ARS population 14,15 , reluctance among clinicians and third-party payer organizations to subject asymptomatic individuals to invasive tests was mentioned in several articles 4,13 . Where measured, Improvements in the inflammatory infiltrate within bronchial lavage samples were also noted 19,20,35 .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical management of reflux is now recognized to be safe and effective in the lung-transplant population; many studies have demonstrated good outcomes 13,14,23,[15][16][17][18][19][20][21][22] , including in patients with end stage lung disease prior to transplantation 24 . However, the level of evidence to support ARS is low, and work needs to be done to define the optimal timing for intervention 25 , and there is an understandable reluctance to submit this group of complex patients to a randomization of therapy and timing thereof .…”

Section: Introductionmentioning

confidence: 99%

Fundoplication to preserve allograft function after lung transplant: Systematic review and meta-analysis

Davidson

Franklin

Kumar

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: This review and pooled analysis sought to demonstrate objective evidence of improved graft function in lung transplant patients undergoing anti-reflux surgery (ARS). Summary Background Data: ARS has been adopted in select patients with lung transplant for the past two decades across many centers. Outcomes have been reported sporadically as retrospective series and no pooled analysis has been performed. Methods:In accordance with MOOSE guidelines, a search of PubMed Central, Medline, Google Scholar and Cochrane Library databases was performed. Papers documenting spirometry data pre-and post-ARS were reviewed and a random-effects model meta-analysis was performed on FEV1 values and the rate of change of FEV1.Results: 6 papers were included in the meta-analysis. Regarding FEV1 before and after ARS, we observed a small increase in FEV1 values in studies reporting raw values in L/1sec(2.02+/-0.89 vs. 2.14+/-0.77, n=154) and % of predicted (77.1+/-22.1 vs. 81.2+/-26.95, n=45), with a 'small' pooled Cohen's d effect size of 0.159(p=0.114). When considering the rate of change of FEV1 (ml/day) we observed a significant difference in pre-ARS compared to post-ARS (-2.12 +/-2.76 ml/day vs. +0.05+/-1.19, n=103). There was a pooled effect size of 1.702(p=0.013), a "large" effect of ARS on the rate of change of FEV1 values. Conclusions:This meta-analysis of retrospective observational studies demonstrates that ARS might benefit patients with declining FEV1 examining the rate of change of FEV1 in the pre-and post-operative periods.

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How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?

Cited by 9 publications

References 22 publications

Impaired Esophageal Motility and Clearance Post-Lung Transplant: Risk For Chronic Allograft Failure

Impaired Esophageal Motility and Clearance Post-Lung Transplant: Risk For Chronic Allograft Failure

Morbidity of antireflux surgery in lung transplant and matched nontransplant cohorts is comparable

Fundoplication to preserve allograft function after lung transplant: Systematic review and meta-analysis

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