title: Gastroesophageal reflux disease is associated with an increased rate of acute rejection in lung transplant allografts.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: N
authors.initials: N
authors.lastname: Shah
authors.forename: S D
authors.initials: SD
authors.lastname: Force
authors.forename: P O
authors.initials: PO
authors.lastname: Mitchell
authors.forename: E
authors.initials: E
authors.lastname: Lin
authors.forename: E C
authors.initials: EC
authors.lastname: Lawrence
authors.forename: K
authors.initials: K
authors.lastname: Easley
authors.forename: J
authors.initials: J
authors.lastname: Qian
authors.forename: A
authors.initials: A
authors.lastname: Ramirez
authors.forename: D C
authors.initials: DC
authors.lastname: Neujahr
authors.forename: A
authors.initials: A
authors.lastname: Gal
authors.forename: K
authors.initials: K
authors.lastname: Leeper
authors.forename: A
authors.initials: A
authors.lastname: Pelaez
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005748:Gastric Fundus / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology*; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000145:classification / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents