title: Impact of gastroesophageal reflux and delayed gastric emptying on pediatric lung transplant outcomes.
abstract: BACKGROUND
  Gastroesophageal reflux disease is thought to predispose to adverse lung allograft outcomes. However, little is known about the burden of gastroesophageal reflux (GER) and gastroparesis in pediatric patients. In this study we describe the burden of reflux and gastroparesis in children undergoing lung transplant, and evaluates their impact on allograft survival and rejection incidence.
  
  
  METHODS
  This study is a retrospective analysis of pediatric lung transplant recipients who had combined pH and multichannel intraluminal impedance testing (pH-MII) and gastric-emptying scans (GES). Hazard ratios with 95% confidence intervals (CIs) estimated from Cox proportional hazard models were used to examine the associations between reflux parameters and adverse allograft outcomes. Covariates considered in the multivariate analysis included abnormal pH-MII testing, abnormal GES and Nissen fundoplication status. Kaplan-Meier curves were created, with log-rank testing employed to assess differences between groups.
  
  
  RESULTS
  Thirty lung transplant recipients, aged 1 to 21 years, were identified. Eight of 30 patients (27%) had abnormal reflux by impedance, and 12 (40%) had abnormal pH-metry. Of 19 patients tested, 5 (26.3%) had evidence of gastric dysmotility; however, the severity of GER did not trend with delays in gastric emptying. Neither reflux burden by pH-MII testing nor fundoplication status impacted survival or rejection. However, delayed gastric emptying appeared significantly linked to the development of chronic lung allograft dysfunction, independent of GER.
  
  
  CONCLUSIONS
  In children, reflux burden and fundoplication status do not impact lung transplant outcomes, but gastric dysmotility may be linked to allograft dysfunction in children.
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Fei
authors.initials: F
authors.lastname: Jamie Dy
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Freiberger
authors.affiliation: Clinical Research Program, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Boyer
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Visner
authors.affiliation: Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA. Electronic address: rachel.rosen@childrens.harvard.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018589:Gastroparesis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D016040:Lung Transplantation; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Impedance; fundoplication; gastroesophageal reflux; gastroparesis; proton pump inhibitor