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. 2010 Sep;42(7):2702-6.
doi: 10.1016/j.transproceed.2010.05.155.

Gastroesophageal reflux disease is associated with an increased rate of acute rejection in lung transplant allografts

N Shah  1 , S D Force, P O Mitchell, E Lin, E C Lawrence, K Easley, J Qian, A Ramirez, D C Neujahr, A Gal, K Leeper, A Pelaez
Affiliations

Gastroesophageal reflux disease is associated with an increased rate of acute rejection in lung transplant allografts

N Shah et al. Transplant Proc. 2010 Sep.

Abstract

Purpose: Gastric fundoplication (GF) for gastroesophageal reflux disease (GERD) may protect against the progression of chronic rejection in lung transplant (LT) recipients. However, the association of GERD with acute rejection episodes (ARE) is uncertain. This study sought to identify if ARE were linked to GERD in LT patients.

Methods: This single-center retrospective observational study, of patients transplanted from January 1, 2000, to January 31, 2009, correlated results of pH probe testing for GERD with ARE (≥International Society for Heart and Lung Transplantation A1 or B1). We compared the rates of ARE among patients with GERD (DeMeester Score > 14.7) versus without GERD as number of ARE per 1,000 patient-days after LT. Patients undergoing GF prior to LT were excluded.

Results: The analysis included 60 LT subjects and 9,249 patient-days: 33 with GERD versus 27 without GERD. We observed 51 ARE among 60 LT recipients. The rate of ARE was highest among patients with GERD: 8.49 versus 2.58, an incidence density ratio (IDR) of 3.29 (P = .00016). Upon multivariate negative binomial regression modeling, only GERD was associated with ARE (IDR 2.15; P = .009). Furthermore, GERD was associated with multiple ARE (36.4% vs 0%; P < .0001) and earlier onset compared with patients without GERD: ARE proportion at 2 months was 0.55 versus 0.26 P = .004).

Conclusion: In LT recipients, GERD was associated with a higher rate, multiple events, and earlier onset of ARE. The efficacy of GF to reduce ARE among patients with GERD needs further evaluation.

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Figures

Fig 1
Fig 1
Selection criteria. *Episodes of AR and patient-days after gastric fundoplication in this group were excluded.
Fig 2
Fig 2
Time to first acute rejection episodes (ARE). P = .004 calculated by log-rank test; GERD = gastroesophageal reflux disease; O = censored if fundoplication before to ARE.
See this image and copyright information in PMC

References

    1. Estenne M, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002;21:297. - PubMed
    1. Sharples LD, et al. Risk factors for bronchiolitis obliterans: a systematic review of recent publications. J Heart Lung Transplant. 2002;21:271. - PubMed
    1. Hopkins PM, et al. Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis. Am J Respir Crit Care Med. 2004;170:1022. - PubMed
    1. Khalifah AP, et al. Minimal acute rejection after lung transplantation: a risk for bronchiolitis obliterans syndrome. Am J Transplant. 2005;5:2022. - PubMed
    1. Ward C, et al. Pepsin like activity in bronchoalveolar lavage fluid is suggestive of gastric aspiration in lung allografts. Thorax. 2005;60:872. - PMC - PubMed

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