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. 2023 Sep 10;9(5):00222-2023.
doi: 10.1183/23120541.00222-2023. eCollection 2023 Sep.

Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients

Rayoun Ramendra  1 , Juan C Fernández-Castillo  1   2 , Ella Huszti  3 , Rasheed Ghany  1 , Meghan Aversa  1   2 , Jan Havlin  1 , Peter Riddell  1 , Cecilia M Chaparro  1 , Lianne G Singer  1   2 , Louis Liu  4 , Shaf Keshavjee  1   5 , Jonathan C Yeung  1   5 , Tereza Martinu  1   2
Affiliations

Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients

Rayoun Ramendra et al. ERJ Open Res. .

Abstract

Background: Morbidity and mortality in lung transplant recipients are often triggered by recurrent aspiration events, potentiated by oesophageal and gastric disorders. Previous small studies have shown conflicting associations between oesophageal function and the development of chronic lung allograft dysfunction (CLAD). Herein, we sought to investigate the relationship between oesophageal motility disorders and long-term outcomes in a large retrospective cohort of lung transplant recipients.

Methods: All lung transplant recipients at the Toronto Lung Transplant Program from 2012 to 2018 with available oesophageal manometry testing within the first 7 months post-transplant were included in this study. Patients were categorised according to the Chicago Classification of oesophageal disorders (v3.0). Associations between oesophageal motility disorders with the development of CLAD and allograft failure (defined as death or re-transplantation) were assessed.

Results: Of 487 patients, 57 (12%) had oesophagogastric junction outflow obstruction (OGJOO) and 47 (10%) had a disorder of peristalsis (eight major, 39 minor). In a multivariable analysis, OGJOO was associated with an increased risk of CLAD (HR 1.71, 95% CI 1.15-2.55, p=0.008) and allograft failure (HR 1.69, 95% CI 1.13-2.53, p=0.01). Major disorders of peristalsis were associated with an increased risk of CLAD (HR 1.55, 95% CI 1.01-2.37, p=0.04) and allograft failure (HR 3.33, 95% CI 1.53-7.25, p=0.002). Minor disorders of peristalsis were not significantly associated with CLAD or allograft failure.

Conclusion: Lung transplant recipients with oesophageal stasis characterised by OGJOO or major disorders of peristalsis were at an increased risk of adverse long-term outcomes. These findings will help with risk stratification of lung transplant recipients and personalisation of treatment for aspiration prevention.

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Conflict of interest statement

Conflicts of interest: P. Riddell is an associate editor of this journal. L. Liu has received honoraria from AbbVie, Medtronic, Lupin, Knight and Bausch Health as a speaker and consultant. S. Keshavjee is a corporate board member for United Therapeutics and current patent holder with SQI Diagnostics. T. Martinu received a research grant from Sanofi Inc. and research material from APCBio Innovations Inc., and collaborates (with no fees) with Trove Therapeutics. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Consolidated Standards of Reporting Trials (CONSORT) diagram of the study population.
FIGURE 2
FIGURE 2
Study participants were categorised based on Chicago Classification v3.0 for oesophageal disorders. LOS: lower oesophageal sphincter; IRP: integrated relaxation pressure; OGJOO: oesophagogastric junction outflow obstruction. These terms are also referred to as lower esophageal sphincter (LES) and esophagogastric junction outflow obstruction (EGJOO) in US English.
FIGURE 3
FIGURE 3
Kaplan–Meier curves assessing the relationship between oesophageal disorders and adverse post-lung transplant outcomes. a) Time to chronic lung allograft dysfunction (CLAD) analysis comparing lung transplant recipients with normal manometry testing (n=383; green), oesophagogastric junction outflow obstruction (OGJOO) (n=57; yellow) and disorders of peristalsis (n=47; red). b) Time to allograft failure analysis comparing lung transplant recipients with normal manometry testing (n=383; green), OGJOO (n=57; yellow) and disorders of peristalsis (n=47; red). c) Time to CLAD analysis comparing lung transplant recipients with normal manometry testing (n=383; green), achalasia (n=6; orange), non-achalasia OGJOO (n=51; yellow), major disorders of peristalsis (n=8; maroon) and minor disorders of peristalsis (n=39; red). d) Time to allograft failure analysis comparing lung transplant recipients with normal manometry testing (n=383; green), achalasia (n=6; orange), non-achalasia OGJOO (n=51; yellow), major disorders of peristalsis (n=8; maroon) and minor disorders of peristalsis (n=39; red). Log-rank analysis.
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