Safe and effective antireflux surgery in lung transplant recipients: preliminary results

Obliterative bronchiolitis, the clinical manifestation of bronchiolitis obliterans syndrome (BOS), is a major complication of lung transplantation and one of the primary causes of chronic lung allograft dysfunction leading to poor survival outcomes.

The aim of this study was to evaluate the safety and outcomes of antireflux surgery in lung transplant recipients (LTRs) with BOS and associated gastroesophageal reflux disease (GERD).

This single-center study included 8 consecutive patients at a median (interquartile range [IQR]) age of 29 (25-46) years who underwent bilateral lung transplantation and subsequent antireflux surgery due to BOS. The decision to proceed with laparoscopic surgery was based on a diagnosis of GERD associated with a decline in pulmonary function, confirmed on bronchoscopy indicative of BOS. Follow-up lasted for 12 months.

Median (IQR) time since transplantation was 27 (15-55.5) months. Significant improvements in spirometric parameters were observed at 3 and 12 months postoperatively, as compared with baseline, including forced expiratory volume in 1 second (FEV₁; P = 0.02), FEV₁% predicted (P = 0.02), forced vital capacity (FVC; P = 0.003), and FVC% predicted (P = 0.02). There were no differences in spirometric parameters between 3 and 12 months postoperatively. No surgical complications were observed within 30 days after surgery or during follow-up. Two patients developed pulmonary complications, and 1 patient with a history of kidney transplantation experienced renal complications. There were no postoperative deaths. Median (IQR) hospital stay was 12 (3-29) days.

The study suggests that antireflux surgery in LTRs is a safe and effective approach for GERD management, while improving lung function with minimal adverse effects.