Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation.
OBJECTIVE
Bronchiolitis obliterans is the greatest limitation to the long-term applicability of lung transplantation. Although alloimmune events are important, nonimmune events, such as gastroesophageal reflux, might contribute to lung injury and the development of bronchiolitis obliterans syndrome.


METHODS
We retrospectively studied the 396 patients who underwent lung transplantation at the Duke Lung Transplant Program from April 1992 to April 2002. Reflux was assessed for using an ambulatory 24-hour esophageal pH probe.


RESULTS
Reflux assessment with an esophageal pH probe was obtained in 128 patients after lung transplantation. Abnormal pH study results were present in 93 (73%) patients. Forty-three patients underwent a surgical fundoplication. There was no in-hospital or 30-day mortality in the patients undergoing fundoplication. At the time of fundoplication, 26 patients met the criteria for bronchiolitis obliterans syndrome. After fundoplication, 16 patients had improved bronchiolitis obliterans syndrome scores, with 13 of these patients no longer meeting the criteria for bronchiolitis obliterans syndrome. In patients at least 6 months after lung transplantation and 6 months after fundoplication, the forced expiratory volume in 1 second improved by an average of 24% (mean forced expiratory volume in 1 second before fundoplication, 1.87 L; mean forced expiratory volume in 1 second after fundoplication, 2.19 L/sec; P <.0002). Overall actuarial survival was significantly better in patients who had either normal pH studies or who had fundoplication.


CONCLUSIONS
Gastroesophageal reflux disease is very common after lung transplantation and appears to contribute to mortality and development of bronchiolitis obliterans syndrome. Fundoplication in lung transplant recipients with gastroesophageal reflux disease is associated with significant improvements in lung function, particularly if performed before the late stages of bronchiolitis obliterans syndrome.
Davis
R Duane
RD
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. daivs053@mc.duke.edu
Lau
Christine L
CL
Eubanks
Steve
S
Messier
Robert H
RH
Hadjiliadis
Denis
D
Steele
Mark P
MP
Palmer
Scott M
SM
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000145:classification / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D018662:Fundoplication / Q000379:methods; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008448:Maximal Expiratory Flow Rate; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome