Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 8:6:100145.
doi: 10.1016/j.jhlto.2024.100145. eCollection 2024 Nov.

Antireflux surgery for prevention of chronic lung allograft dysfunction (CLAD) onset after lung transplantation: The earlier the better before CLAD onset? A single-center series of 284 patients

Abdulmonem Hamid  1   2 , Alexandre Vallée  3 , Sophie Rong  1 , Olivier Boche  4 , Sandra De Miranda  1 , Laurence Beaumont-Azuar  1 , Sylvie Colin de Verdière  1 , Dominique Grenet  1 , Marc Stern  1 , Benjamin Zuber  5 , Jerôme Devaquet  5 , Julien Fessler  6 , Julien De Wolf  7 , Ciprian Pricopi  7 , Matthieu Glorion  7 , Edouard Sage  7   8 , Jonathan Messika  5 , Antoine Magnan  1 , François Parquin  5 , Clément Picard  1 , Antoine Roux  1   8 , Olivier Brugière  1   9
Affiliations

Antireflux surgery for prevention of chronic lung allograft dysfunction (CLAD) onset after lung transplantation: The earlier the better before CLAD onset? A single-center series of 284 patients

Abdulmonem Hamid et al. JHLT Open. .

Abstract

Background: Gastroesophageal reflux disease (GERD) is highly prevalent after lung transplantation (LTx) and is suspected to favor the development of chronic lung allograft dysfunction (CLAD), almost of bronchiolitis obliterans syndrome (BOS) phenotype. The preventive effect of antireflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort.

Methods: Data from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry.

Results: Among 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p = 0.03). An increase in donor-specific antibodies' mean fluorescence intensity values was observed only in GERD after LTx (M6 vs day 0, p < 0.0001; M12 vs day 0, p = 0.003). Freedom from CLAD at 3 years post-pHmetry/ARS was higher for GERD-ARS patients as compared to GERD-noARS patients (p = 0.002). Additionally, ARS was independently associated with a subsequent decreased risk of CLAD onset at 3 years in GERD patients (GERD-ARS vs GERD-noARS, p = 0.02 [Cox models]). ARS was safe in this series, with no surgery-related deaths.

Conclusions: Our results suggested a preventive effect of ARS on CLAD onset in stable selected patients with GERD, with a beneficial medium-term effect.

Irb approval number: IRB00012437.

Keywords: DSA; antireflux surgery; gastroesophageal reflux; graft dysfunction; lung transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest. This study did not benefit from funding.

Figures

Figure 1
Figure 1
Flowchart of patients.
Figure 2
Figure 2
Comparison of freedom from chronic lung allograft dysfunction (CLAD) at 3 years post-pHmetry/ARS between GERD-ARS patients, GERD-noARS patients, and noGERD patients, in patients free of CLAD at the date of pHmetry or ARS (n = 244 patients). ARS, antireflux surgery; GERD, gastroesophageal reflux disease; LTx, lung transplantation.
Figure 3
Figure 3
Comparison of graft survival at 3 years post-pHmetry/ARS between GERD-ARS patients, GERD-noARS patients, and noGERD patients in patients free of CLAD at the date of pHmetry or ARS (n = 244 patients). ARS, antireflux surgery; GERD, gastroesophageal reflux disease; LTx, lung transplantation.
See this image and copyright information in PMC

References

    1. Kotloff R.M., Thabut G. Lung transplantation. Am J Respir Crit Care Med. 2011;184:159–171. - PubMed
    1. Chambers D.C., Yusen R.D., Cherikh W.S., et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1047–1059. - PubMed
    1. Verleden G.M., Glanville A.R., Lease E.D., et al. Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019;38:493–503. - PubMed
    1. Glanville A.R., Verleden G.M., Todd J.L., et al. Chronic lung allograft dysfunction: definition and update of restrictive allograft syndrome-a consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019;38:483–492. - PubMed
    1. Meyer K.C., Raghu G., Verleden G.M., et al. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 2014;44:1479–1503. - PubMed

LinkOut - more resources