title: Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) in lung recipients is associated with decreased survival and attenuated allograft function. This study evaluates fundoplication in preventing GERD-related allograft dysfunction.
  
  
  METHODS
  Prospectively collected data on patients who underwent transplantation between January 2001 and August 2009 were included. Lung transplant candidates underwent esophageal pH probe testing before transplantation and surveillance spirometry evaluation after transplantation. Bilateral lung transplant recipients who had pretransplant pH probe testing and posttransplant 1-year forced expiratory volume in the first second of expiration (FEV1) data were included for analysis.
  
  
  RESULTS
  Of 297 patients who met study criteria, 222 (75%) had an abnormal pH probe study before or early after transplantation and 157 (53%) had a fundoplication performed within the first year after transplantation. Patients with total proximal acid contact times greater than 1.2% or total distal acid contact times greater than 7.0% demonstrated an absolute decrease of 9.4% (±4.6) or 12.0% (±5.4) in their respective mean 1-year FEV1 values. Patients with abnormal acid contact times who did not undergo fundoplication had considerably worse predicted peak and 1-year FEV1 results compared with recipients receiving fundoplication (peak percent predicted=75% vs. 84%; p=0.004 and 1-year percent predicted=68% vs. 77%; p=0.003, respectively).
  
  
  CONCLUSIONS
  Lung transplant recipients with abnormal esophageal pH studies attain a lower peak allograft function as well as a diminished 1-year FEV1 after transplantation. However a strategy of early fundoplication in these recipients appears to preserve lung allograft function.
authors.affiliation: Division of Thoracic Surgery, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Shekur
authors.initials: S
authors.lastname: Reddy
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
mesh_terms: D003131:Combined Modality Therapy; D050782:Esophageal pH Monitoring; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000503:physiopathology / Q000517:prevention & control*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010348:Patient Care Team; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D013147:Spirometry