Gastroesophageal Reflux Disease Is Associated With an Increased Rate of Acute Rejection in Lung Transplant Allografts

• Published in: Transplantation proceedings 2010-09, Vol.42 (7), p.2702-2706
• Main Authors: Shah, N, Force, S.D, Mitchell, P.O, Lin, E, Lawrence, E.C, Easley, K, Qian, J, Ramirez, A, Neujahr, D.C, Gal, A, Leeper, K, Pelaez, A
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Cytomegalovirus Infections - epidemiology; Esophagus; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastric Fundus - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - epidemiology; Gastroesophageal Reflux - etiology; Graft Rejection - epidemiology; Humans; Immunosuppressive Agents - therapeutic use; Lung Diseases - classification; Lung Diseases - surgery; Lung Transplantation - adverse effects; Lung Transplantation - immunology; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transplantation, Homologous
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.05.155

Abstract Purpose Gastric fundoplication (GF) for gastroesophageal reflux disease (GERD) may protect against the progression of chronic rejection in lung transplant (LT) recipients. However, the association of GERD with acute rejection episodes (ARE) is uncertain. This study sought to identify if ARE were linked to GERD in LT patients. Methods This single-center retrospective observational study, of patients transplanted from January 1, 2000, to January 31, 2009, correlated results of pH probe testing for GERD with ARE (≥International Society for Heart and Lung Transplantation A1 or B1). We compared the rates of ARE among patients with GERD (DeMeester Score > 14.7) versus without GERD as number of ARE per 1,000 patient-days after LT. Patients undergoing GF prior to LT were excluded. Results The analysis included 60 LT subjects and 9,249 patient-days: 33 with GERD versus 27 without GERD. We observed 51 ARE among 60 LT recipients. The rate of ARE was highest among patients with GERD: 8.49 versus 2.58, an incidence density ratio (IDR) of 3.29 ( P = .00016). Upon multivariate negative binomial regression modeling, only GERD was associated with ARE (IDR 2.15; P = .009). Furthermore, GERD was associated with multiple ARE (36.4% vs 0%; P < .0001) and earlier onset compared with patients without GERD: ARE proportion at 2 months was 0.55 versus 0.26 P = .004). Conclusion In LT recipients, GERD was associated with a higher rate, multiple events, and earlier onset of ARE. The efficacy of GF to reduce ARE among patients with GERD needs further evaluation.