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Published on: October 11, 2024
412
Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study.
Cynthia L Green1, Brian C Gulack2, Shaf Keshavjee3
1Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
The Annals of Thoracic Surgery
|October 10, 2022
Summary
Fundoplication may not significantly improve outcomes after lung transplantation, but further research is needed to confirm its benefits for preventing graft dysfunction and improving survival in patients with reflux disease.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Pulmonary medicine
Background:
- Gastroesophageal reflux disease (GERD) is a concern in lung transplant recipients.
- Aspiration associated with GERD may lead to graft dysfunction.
- The role of fundoplication in managing GERD post-transplant is debated due to limited evidence.
Purpose of the Study:
- To investigate the association between GERD, fundoplication, and outcomes in lung transplant recipients.
- To evaluate the impact of fundoplication on bronchiolitis obliterans syndrome (BOS) and patient survival.
Main Methods:
- Multicenter retrospective study involving 542 lung transplant patients.
- Analysis of data from 4 academic lung transplant centers.
- Cox multivariable regression used to assess the association of GERD and fundoplication with BOS and survival.
Main Results:
- Fundoplication was performed in 136 patients; 99 had GERD without fundoplication.
- Excluding the first post-transplant year, fundoplication showed no significant benefit in freedom from BOS or death compared to GERD alone.
- A time-dependent analysis suggested a potential trend towards decreased mortality and BOS with fundoplication, though not statistically significant.
Conclusions:
- The study did not find statistically significant benefits of fundoplication for lung transplant recipients with GERD.
- Limited sample size, follow-up duration, and potential selection bias may have influenced the results.
- A randomized, prospective study is recommended to definitively assess the efficacy of fundoplication in this patient population.
