Delayed Gastric Emptying Before Lung Transplant Affects Transplant Outcomes

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Investigators assessed the relationship between pretransplant delayed gastric emptying and post-transplant acute cellular rejection in patients undergoing lung transplant.

Delayed gastric emptying (DGE) before lung transplant is highly prevalent and is associated with poor transplant outcomes, according to a study published in the Journal of Clinical Gastroenterology.

DGE may lead to undesirable post-transplant outcomes by predisposing patients to microaspiration. While DGE is common after lung transplantation, pretransplant prevalence has not been established. Pretransplant testing for DGE may help to identify patients at risk for these negative post-transplant outcomes, including acute cellular rejection (ACR).

Researchers sought to evaluate the relationship between DGE and post-transplant ACR in lung transplant recipients by conducting a retrospective review of patients undergoing prelung transplant evaluation at a tertiary referral center from 2010 to 2015.

In total, 83 patients were included in the analysis (51.8% men; median age, 53.6 years). The most prevalent diagnosis requiring transplant was idiopathic pulmonary fibrosis (27.7%). According to prelung transplant gastric emptying scintigraphy, 21.7% of patients had DGE.

The researchers found that patients with DGE were more likely to have typical symptoms of gastroparesis, although 61.1% were asymptomatic. However, ACR was more prevalent in patients with DGE than without DGE (33.3% vs. 12.3%; P =.04). This correlation was independent of gastroesophageal reflux (GER). In an analysis of patients with no evidence of GER (n=18), those with DGE remained at higher risk for ACR (75% vs. 14.3%). Only 7 patients demonstrated increased GER and all 7 patients had normal gastric emptying and no evidence of ACR.

This study was limited by its moderate sample size and retrospective design. Additionally, study author were unable to assess whether interventions designed to target DGE could affect patient outcomes.

The researchers concluded, “Lung transplant recipients with pretransplant DGE have a higher incidence of ACR, independent of GER.” “Because the majority of patients with DGE did not report typical symptoms, routine pretransplant testing for DGE may help identify patients at risk for adverse posttransplant outcomes.” Further research is needed on the mechanisms of DGE and allograft injury.


Derousseau T, Chan WW, Cangemi D, Kaza V, Lo W-K, Gavini S. Delayed gastric emptying in prelung transplant patients is associated with posttransplant acute cellular rejection independent of reflux. J Clin Gastroenterol. 2022;56(2):e121-e125. doi: 10.1097/MCG.0000000000001502