Pretransplant gastroesophageal reflux disease (GERD) was not found to be associated with mortality or acute rejection following lung transplantation, according to study data presented at the American College of Gastroenterology’s 2020 Virtual Meeting, held online October 23-28, 2020. However, pretransplant gastroparesis appeared to be independently associated with transplant rejection and posttransplant death.

Investigators conducted a retrospective cohort study of patients who underwent lung transplantation between 2009 and 2019 at Vanderbilt University Medical Center. They defined GERD based on DeMeester score and/or the presence of Barrett esophagus, peptic strictures, or esophagitis. Primary outcomes were mortality after lung transplantation, acute rejection of transplant, and the development of chronic lung allograft dysfunction (CLAD). The researchers determined acute rejection by biopsy and used time-to-event and Cox proportional hazards models to assess the relationship between pretransplant GERD and posttransplant outcomes. The researchers adjusted the models for age, sex, body mass index, and transplant status (single vs double lung transplant).

The study cohort comprised 227 patients who underwent lung transplantation. The most frequent indications for lung transplant were idiopathic pulmonary fibrosis (30%), chronic obstructive pulmonary disease (26%), and cystic fibrosis (19%). Among 72 patients who underwent pretransplant reflux testing, 39 (55.8%) met criteria for GERD. Overall, 28.2% of the total cohort died after transplant, among whom 62.5% had a pretransplant diagnosis of GERD. However, in time-to-event analyses, GERD was not predictive of time to death. Moreover, GERD was not significantly associated with time to acute rejection or the development of CLAD. GERD was negatively associated with the presence of gastroparesis: 8 patients in the non-GERD cohort had gastroparesis compared with 0 patients in the GERD cohort. Gastroparesis was independently associated with death and acute rejection.


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In this 10-year cohort study, the investigators identified no association between a pretransplant diagnosis of GERD and posttransplant mortality, rejection, or CLAD; however, gastroparesis appeared to predict mortality and acute rejection in a small subcohort of patients.

“Overall, early identification and management of GERD as per our routine practice shows that pretransplant GERD diagnosis does not worsen posttransplant outcomes,” investigators wrote. “Prospective studies on dose of acid suppression, timing of anti-reflux surgeries, and uniform standards of pretransplant evaluation are needed.”

Reference

Meyers MH, Hayat MH, Tombazzi CR, et al. Pre-transplant GERD does not predict post-lung transplant mortality, acute rejection, or chronic rejection: a 10-year retrospective review. ePoster presented at: American College of Gastroenterology (ACG) 2020 Virtual Annual Scientific Meeting & Postgraduate Course; October 23-28, 2020. P0910 (S0436).