title: Anti-reflux surgery for lung transplant recipients in the presence of impedance-detected duodenogastroesophageal reflux and bronchiolitis obliterans syndrome: a study of efficacy and safety.
abstract: BACKGROUND
  The aim of this study was to determine the safety of anti-reflux surgery for lung transplant recipients and assess its effect on lung function.
  
  
  METHODS
  We retrospectively collected and analyzed data from all lung transplant recipients who underwent anti-reflux surgery at St Mary's Hospital London from July 2005 to May 2012. The indications for surgery were histologic evidence of gastroesophageal reflux aspiration on bronchoscopy biopsy specimens or a positive impedance study with symptomatic reflux or a consistent decline/fluctuating forced expiratory volume in 1 second (FEV(1)). We studied the difference in mean FEV(1) and rate of change of FEV(1), before and after fundoplication. The safety of anti-reflux surgery was determined by post-operative morbidity and mortality and compared with predicted figures, using a risk prediction model based on the P-POSSUM (Portsmouth Modification of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) assessment.
  
  
  RESULTS
  Forty patients underwent laparoscopic Nissen fundoplication. Overall, mean FEV(1) declined from 2119 ± 890 to 1967 ± 1027 ml (p = 0.027), and mean rate of change in FEV(1) improved from -2.42 ± 4.40 to -0.41 ± 1.77 ml/day (p = 0.007). Patients referred for fundoplication based on histologic evidence of reflux (n = 9) showed an improvement in rate of change of FEV(1) from -3.39 ± 6.00 to -0.17 ± 1.50 ml/day (p = 0.057), and those with positive impedance study and consistent decline in FEV(1) (n = 13) showed a significant improvement from -3.62 ± 3.35 to -0.74 ± 2.33 ml (p = 0.021). Actual and predicted morbidity was 2.5% and 31%, respectively. Actual and predicted 30-day mortality was 0% and 1.9%, respectively.
  
  
  CONCLUSIONS
  Anti-reflux surgery is safe for lung transplant recipients and results in an improvement in the rate of change in FEV(1) despite a decline in mean FEV(1) post-operatively.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London.
authors.forename: Nima
authors.initials: N
authors.lastname: Abbassi-Ghadi
authors.forename: Sacheen
authors.initials: S
authors.lastname: Kumar
authors.forename: Billy
authors.initials: B
authors.lastname: Cheung
authors.forename: Anne
authors.initials: A
authors.lastname: McDermott
authors.forename: Alison
authors.initials: A
authors.lastname: Knaggs
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Martin
authors.initials: M
authors.lastname: Carby
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000503:physiopathology / Q000601:surgery*; D004383:Duodenogastric Reflux / Q000503:physiopathology / Q000601:surgery*; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014180:Transplantation; D016896:Treatment Outcome