Incidence and Impact of Gastroparesis After Lung Transplantation

Abstract

PURPOSE:Gastroparesis is a post lung transplant (LTx) complication that can result from immunosuppression, vagal nerve injury, and underlying lung disease. We aimed to define the incidence, risk factors, and impact of gastroparesis following LTx.METHODS: Baseline characteristics of age, type of transplant, gender, and underlying disease of patients who underwent lung transplantation at our center between 1/1/12 and 1/1/17 were collected. Post-LTx outcomes including hospital length of stay, feeding tube placement, need for acute rehabilitation, and post-LTx survival were compared between those with and without gastroparesis.RESULTS: Of 116 LTx patients, 17 (15%) had gastroparesis after LTx. Females (58% vs. 25%, p=0.01), bilateral LTx recipients (63% vs 33%, OR 3.38; p=0.02) and cystic fibrosis (CF) patients (18% vs 3%, p=0.04) were more likely to have post LTx gastroparesis. The gastroparesis group required more gastrojejunostomy tubes (65% vs 1% p<0.001) with more days without oral intake (5.5 vs 0 p <0.001). There was a trend toward longer hospital length of stay (60 vs. 29 days), greater need for acute rehabilitation, and reduced survival (median of 27.2 months vs. undefined due to inadequate follow-up time, p=0.1) in patients with gastroparesis compared to those without. CONCLUSIONS:Post-LTx gastroparesis appears to be more common among women, CF patients and bilateral LTx recipients. It is associated with increased need for feeding tube placement, longer hospital length of stay, debility, and attenuated posttransplant survival.CLINICAL IMPLICATIONS: Gastroparesis after LTx is a risk factor for poor outcomes and should be diagnosed and treated aggressively. A thorough evaluation for gastroparesis should be performed prior to LTx with consideration of single lung procedure in high risk patients, where clinically appropriate.