title: Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) is implicated as a risk factor for bronchiolitis obliterans syndrome after lung transplantation, but its effects on acute rejection, early allograft function, and survival are unclear. Therefore, we sought to systematically understand the time-related impact of pretransplant GERD on graft function (spirometry), mortality, and acute rejection early after lung transplantation.
  
  
  METHODS
  From January 2005 to July 2008, 215 patients underwent lung transplantation; 114 had preoperative pH testing, and 32 (28%) had objective evidence of GERD. Lung function was assessed by forced 1-second expiratory volume (FEV(1); percent of predicted) in 97 patients, mortality by follow-up (median, 2.2 years), and acute rejection by transbronchial biopsy.
  
  
  RESULTS
  Pretransplant GERD was associated with decreased FEV(1) early after lung transplantation (P = .01) such that by 18 months, FEV(1) was 70% of predicted in double lung transplant patients with GERD versus 83% among non-GERD patients (P = .05). A similar decrease was observed in single lung transplantation (50% vs 60%, respectively; P = .09). GERD patients had lower survival early after transplant ( P = .02)-75% versus 90%. Presence of GERD did not affect acute rejection (P = .6).
  
  
  CONCLUSIONS
  For lung transplant recipients, pretransplant GERD is associated with worse early allograft function and survival, but not increased acute rejection. The compromise in lung function is substantial, such that FEV(1) after double lung transplant in GERD patients approaches that of single lung transplant in non-GERD patients. We advocate thorough testing for GERD before lung transplantation; if identified, aggressive therapy early after transplant, including fundoplication, may prove efficacious.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. murthys1@ccf.org
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Marie M
authors.initials: MM
authors.lastname: Budev
authors.forename: Anthony I
authors.initials: AI
authors.lastname: Nunez
authors.forename: Lucy
authors.initials: L
authors.lastname: Thuita
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Chapman
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000401:mortality; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008171:Lung Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D009820:Ohio; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome