title: Assessing oropharyngeal dysphagia after lung transplantation: altered swallowing mechanisms and increased morbidity.
abstract: BACKGROUND
  Gastroesophageal reflux is associated with lung transplantation (LT) and bronchiolitis obliterans syndrome, limiting allograft functional longevity. LT patients may also develop post-operative oropharyngeal dysphagia, exposing the allograft to further risk. However, the magnitude of this problem is unknown. We examined LT recipients post-operatively for swallowing disorders and correlated findings with pre- and post-operative variables.
  
  
  METHODS
  Two hundred sixty-three LT patients (January 2001 to July 2005) at a single center were retrospectively reviewed. Each underwent clinical swallowing assessment. Provocative swallowing evaluation (SE) was performed in 149 patients (Group 1); 114 patients did not receive formal SE (Group 2). SE studies were considered positive with laryngeal penetration (PEN) or tracheal aspiration (ASP) of thin liquids. Groups were compared with respect to pre-, peri- and post-operative variables using analysis of variance (ANOVA) and chi-square tests.
  
  
  RESULTS
  After LT, 56.7% of patients underwent post-operative SE (mean 19 +/- 20 days), most of whom (87.9%) had fiber-optic endoscopic studies. SE was positive for PEN or ASP in 70.5% (n = 105). Aspiration occurred in 63.8% (n = 67) of positive SEs; 77.6% (n = 52) of ASP assessments were clinically silent. Pre-operative gastroesophageal reflux disease (GERD) and post-operative complications, including vocal cord paresis, pleural processes, venous thromboses and severe rejection episodes, were more common among Group 1. Group 2 had a significantly reduced hospital length of stay (p = 0.004).
  
  
  CONCLUSIONS
  Prospective SE identified strikingly high rates of dysphagia after LT. Because many of these deficits are silent, aggressive pulmonary toilet is especially important after post-operative LT. Pre-operative SE may clarify those at increased risk for new-onset oropharyngeal dysphagia after LT.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA. broadus.atkins@keesler.af.mil
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Trachtenberg
authors.forename: Rebecca
authors.initials: R
authors.lastname: Prince-Petersen
authors.forename: Gina
authors.initials: G
authors.lastname: Vess
authors.forename: Errol L
authors.initials: EL
authors.lastname: Bush
authors.forename: Keki R
authors.initials: KR
authors.lastname: Balsara
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
mesh_terms: D000328:Adult; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007830:Larynx / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014132:Trachea / Q000503:physiopathology