[Gastroesophageal reflux as a cause of pulmonary dysfunction after lung transplantation]

Area of Science:

• Transplantation immunology
• Gastroenterology
• Pulmonary medicine

Background:

• Gastroesophageal reflux (GER) is a known risk factor for allograft dysfunction in lung transplant recipients.
• Microaspiration, inflammation, and obliterative bronchiolitis are potential consequences of GER post-lung transplant.

Observation:

• A 16-year-old male with interstitial lung disease underwent bilateral lung transplantation.
• Post-transplant, the patient exhibited significantly reduced lung function (FVC 33%, FEV1 28% predicted).
• Gastroesophageal reflux was identified as the sole positive finding after extensive investigation.

Findings:

• Initial pyeloplasty failed to improve lung function, with persistent GER confirmed by pH monitoring.
• Laparoscopic fundoplication 9 months post-transplant led to gradual improvement in lung function (FVC 44%, FEV1 33% predicted).

Implications:

• This case highlights the critical role of managing gastroesophageal reflux in lung transplant recipients.
• Surgical intervention, specifically fundoplication, can be effective in improving allograft function when GER is a contributing factor.
• Early identification and management of GER may improve long-term outcomes for lung transplant patients.