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

• Type of Material: Article
• Authors: Kenneth Leeper Jr., Emory University; N.S. Shah, Emory University; Seth Force, Emory University; P.O. Mitchell, Emory University; Edward Lin, Emory University; E. Lawrence, Emory University; Kirk Easley, Emory University; J. Qian, Emory University; A. Ramirez, Emory University; David Neujahr, Emory University; Anthony Gal, Emory University; K. Leeper, Emory University; A. Pelaez, Emory University
• Language: English
• Date: 2010-09-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.transproceed.2010.05.155
• Title of Journal or Parent Work: Transplantation Proceedings
• ISSN: 0041-1345
• Volume: 42
• Issue: 7
• Start Page: 2702
• End Page: 2706
• Keywords: BRONCHIOLITIS-OBLITERANS-SYNDROME; PEPSIN; Life Sciences & Biomedicine; FUNDOPLICATION; PREVALENCE; Surgery; Immunology; RISK-FACTORS; Science & Technology; GASTRIC ASPIRATION; DIAGNOSIS; BASILIXIMAB; Transplantation; DYSFUNCTION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Immunology

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.