Increased reflux burden on pre-transplant reflux testing independently predicts significant pulmonary function decline after lung transplantation  

作　　者：Wai-Kit Lo Annel M Fernandez Natan Feldman Nirmal Sharma Hilary J Goldberg Walter W Chan 

机构地区：[1]Department of Gastroenterology,Hepatology,and Endoscopy,Brigham and Women’s Hospital,Boston,MA 02115,United States [2]Department of Medicine,Brigham and Women’s Hospital,Boston,MA 02115,United States [3]Department of Pulmonary and Critical Care Medicine,Brigham and Women’s Hospital,Boston,MA 02115,United States

出　　处：《World Journal of Transplantation》2025年第3期101-109,共9页世界移植杂志(英文)

摘　　要：BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all s

关 键 词：Gastroesophageal reflux disease Lung transplant Multichannel intraluminal impedance pH-monitoring Bronchiolitis obliterans syndrome Chronic rejection 

分 类 号：R655.3[医药卫生—外科学]