Impact of gastro-jejunostomy tube in lung transplant patients: a propensity-matched analysis

Abstract

Objectives During the postoperative phase of lung transplantation, the surgical creation of a gastro-jejunostomy may be deemed necessary for patients with severe esophageal dysmotility, prolonged oral intake difficulties stemming from use of a ventilator or marked malnutrition. We explored the effects of postoperative gastro-jejunostomy tube on survival and bronchiolitis obliterans syndrome in lung transplant recipients. Methods We retrospectively reviewed all lung transplants performed at our institution between 2011 and 2022. Propensity score matching was performed to match patients who required a gastro-jejunostomy tube with control patients on a 1:1 ratio. The preoperative, operative, and postoperative outcomes of the patients were evaluated. Results After propensity score matching, 193 patients with gastro-jejunostomy were compared to 193 patients without gastro-jejunostomy. Patients with gastro-jejunostomy had significantly higher rates of delayed chest closure (p = 0.007), and postoperative dialysis (p = 0.016), longer intensive care unit stays (p < 0.001), longer ventilator duration (p < 0.001), higher rates of pneumonia (p = 0.035) and higher rates of being treated for acute cellular rejection within one year of transplant (p = 0.008). Overall survival and freedom from bronchiolitis obliterans syndrome were not found to be significantly different between the matched groups (p = 0.09 and p = 0.3). Conclusions Gastro-jejunostomy tube placement during the postoperative phase of lung transplantation did not compromise patient survival or freedom from bronchiolitis obliterans syndrome although the results reflect more difficult and complicated cases. This study indicates that the gastro-jejunostomy tube may be a useful option for enteral feeding. Institutional review board number and date of approval STUDY20050181: 6/15/2020