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Pre-transplant impedance measures of reflux are associated with early allograft injury after lung transplantation
Open accessAbstract
Background Acid reflux has been associated with poorer outcomes after lung transplantation. Standard pre-transplant reflux assessment has not been universally adopted. Non-acid reflux may also induce a pulmonary inflammatory cascade, leading to acute and chronic rejection. Esophageal multichannel intraluminal impedance and pH testing (MII-pH) may be valuable in standard pre-transplant evaluation. We assessed the association between pre-transplant MII-pH measures and early allograft injury in lung transplant patients.Methods This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant MII-pH at a tertiary center from 2007 to 2012. Results from pre-transplant MII-pH, cardiopulmonary function testing, and results of biopsy specimen analysis of the transplanted lung were recorded. Time-to-event analyses were performed using Cox proportional hazards and Kaplan-Maier methods to assess the associations between MII-pH measures and development of acute rejection or lymphocytic bronchiolitis.Results Thirty patients (46.7% men; age, 54.2 years) met the inclusion criteria. Pre-transplant cardiopulmonary function and pulmonary diagnoses were similar between outcome groups. Prolonged bolus clearance (hazard ratio [HR], 4.11; 95% confidence interval [CI], 1.34-12.57; p = 0.01), increased total distal reflux episodes (HR, 4.80; 95% CI, 1.33-17.25; p = 0.02), and increased total proximal reflux episodes (HR, 4.43; 95% CI, 1.14-17.31; p = 0.03) were significantly associated with decreased time to early allograft injury. Kaplan-Meier curves also demonstrated differences in time to rejection by prolonged bolus clearance (p = 0.01) and increased total distal reflux episodes (p = 0.01). Sub-group analysis including only patients with MII-pH performed off proton pump inhibitors (n = 24) showed similar results.Conclusions Prolonged bolus clearance, increased total distal reflux episodes, and increased total proximal reflux episodes on pre-transplant MII-pH were associated with decreased time to early allograft injury after lung transplantation. Routine pre-transplant MII-pH may provide clinically relevant data regarding transplant outcomes and peri-transplant care.
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Post-transplant gastroesophageal reflux is associated with acute rejection, pulmonary infection, and earlier chronic lung allograft dysfunction.
“Post-transplant GER is variably associated with increased risk of acute rejection, pulmonary infection and earlier development of chronic lung allograft dysfunction (CLAD).(32, 33)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [32]
The paper’s introductory passage (page unavailable) reports associations of post-transplant reflux or aspiration with acute rejection and early-onset bronchiolitis obliterans syndrome, a form of chronic allograft dysfunction. It does not link reflux to pulmonary infection; it names infection as a possible cause of lymphocytic bronchiolitis instead. Its own subgroup analysis also found no association between pre-transplant reflux severity and acute rejection assessed separately. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPost-transplant GER is variably associated with increased risk of acute rejection, pulmonary infection, and earlier development of chronic lung allograft dysfunction.
“Post-transplant GER is variably associated with increased risk of acute rejection, pulmonary infection and earlier development of chronic lung allograft dysfunction (CLAD).(32, 33)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [32]
The paper’s introductory passage (labeled Abstract in our copy; page unavailable) reports associations of reflux or aspiration with acute rejection and early-onset bronchiolitis obliterans syndrome, a manifestation of chronic allograft injury. It does not link GER to increased pulmonary infection; it discusses infection as a possible alternative cause of lymphocytic bronchiolitis. The Discussion also says this study could not reliably assess longer-term bronchiolitis obliterans outcomes. (LLM, conf=0.86)
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“Esophageal Dysfunction / Gastrointestinal Dysmotility/ Gastroesophageal reflux (GER): Post-transplant GER is variably associated with increased risk of acute rejection, pulmonary infection and earlier development of chronic lung allograft dysfunction (CLAD).(32,33) Anti-reflux surgery pre-transplant and early post-tra…”
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Lo, W., Wee, J. O., Fisichella, P. M., & Chan, W. W. (2015) · Gastroenterology · doi:10.1016/s0016-5085(15)33778-1 · Cited by 1
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Pulmonary Complications of Gastroesophageal Reflux Disease
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Primary Care of the Adult Lung Transplant Recipient
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Impact of Antireflux Surgery on Interstitial Lung Disease and Lung Transplantation
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Metadata
- Authors
- Lo, W.-K., Burakoff, R., Goldberg, H. J., Feldman, N., & Chan, W. W.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Chan, Walter W.
- Venue
- The Journal of Heart and Lung Transplantation
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 34
- Issue
- 1
- Pages
- 26-35
- ISSN
- 1053-2498 (ISSN-L)
- OpenAlex
- W2160826233
- Semantic Scholar
- 1c706379df4fd0592d4b688ccc1904fd004f6b86
- Cited by
- 64
- References
- 38
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 3 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 2 · 2015: 7
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Heart and Lung Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- lung transplantation, gastroesophageal reflux, pre-transplant evaluation, acute rejection, lymphocytic bronchiolitis, bolus clearance, proton pump inhibitors, lung inflammation, transplant outcomes
- MeSH terms
- Acute Disease, Female, Follow-Up Studies, Gastroesophageal Reflux, Graft Rejection, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Prognosis, Respiratory Insufficiency, Retrospective Studies, Time Factors, Incidence, Lung Transplantation, Electric Impedance, Esophageal pH Monitoring, Preoperative Period, Allografts
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