Association of Foregut Testing and Intervention on Lung Transplant Outcomes
Sean Dewberry1, Gevork Salmastyan1, Imam Sanousi1
1Department of Medicine, Division of Gastrointestinal and Liver Diseases, Swallowing and Esophageal Disorders Center.
Goals:
To evaluate the association between multimodal foregut testing, surgical intervention, and outcomes after lung transplantation.
Background:
Gastroesophageal reflux and other foregut disorders have been linked to adverse lung transplant outcomes. However, the impact of comprehensive pre- and posttransplant foregut evaluation and targeted intervention remains unclear.
Study:
We reviewed lung transplant recipients at a single center from February 2013 to April 2023. Data included demographics, pre- and posttransplant endoscopy, esophageal manometry, pH monitoring, esophagram, gastric emptying studies, and fundoplication status. The primary outcomes were the incidence, timing, and severity of acute cellular rejection, as well as mortality.
Results:
Among 197 patients (median age 57 years old; 52% female), foregut testing patterns shifted post-transplant, with esophagram most frequent pre-transplant (44%) and gastric emptying studies most frequent post-transplant (62%). Manometry results were unchanged in 75% of patients, and gastric emptying studies in 27%. Over half developed new delayed gastric emptying posttransplant, including patients after fundoplication. Barrett's esophagus was associated with increased mortality risk. Fundoplication, typically performed in patients with abnormal pH studies, was linked to higher acute rejection incidence but lower severity and reduced mortality.
Conclusions:
Comprehensive foregut evaluation before and after lung transplantation reveals high rates of abnormal motility and reflux, dynamic posttransplant physiological changes, and an association between Barrett's esophagus and mortality. Structured foregut testing may help identify high-risk patients and guide timely intervention to improve outcomes.
