Interventional Anti-reflux Management for Gastro-oesophageal Reflux Disease in Lung Transplant Recipients: a Systematic Review and Meta-analysis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2024 Nov 25

PMID 39586876

Authors

Oliver Krahelski

Iihan Ali

Christopher Namgoong

Kavita Dave

Anna Reed

Hutan Ashrafian

Marcus Reddy

Omar Khan

Bibek Das

Matyas Fehervari

Affiliations

Soon will be listed here.

Abstract

Introduction: Gastroesophageal reflux disease (GORD) and aspiration are risk factors in the development of bronchiolitis obliterans syndrome (BOS) in the lung transplant population. The aim of this study was to investigate if allograft function and survival improved after anti-reflux surgery (ARS) in lung transplant recipients.

Methods: In accordance with PRISMA guidelines, we conducted a systematic search of MEDLINE, Embase, and the Cochrane library databases from inception until 13/01/2024. Articles reporting outcomes of ARS following lung transplantation were included. A random effects model was used for meta-analysis.

Results: The search identified 20 which were used for quantitative analysis. Overall, FEV1 and rate of change of FEV1 had improved following ARS by 0.141 L/s (95% CI; -02.82, -0.001) and -1.153 mL/d (95% CI; -12.117, -0.188), respectively. Survival hazard ratio post-ARS was 0.39 (95% CI; 0.19, 0.60). Nissen fundoplication was the most effective anti-reflux procedure with the greatest effect on reduction in the rate of change of FEV1, with an improvement of -2.353 mL/d (95% CI; -3.058, -1.649).

Conclusion: ARS in lung transplant recipients improves allograft function and survival. Given the increased incidence of GORD in lung transplant recipients, there should be a low threshold for investigation of GORD and subsequent ARS.

References

Aguilar P, Michelson A, Isakow W . Obliterative Bronchiolitis. Transplantation. 2015; 100(2):272-83. DOI: 10.1097/TP.0000000000000892. View

Duarte A, Myers A . Cough reflex in lung transplant recipients. Lung. 2011; 190(1):23-7. DOI: 10.1007/s00408-011-9352-x. View

Shah N, Force S, Mitchell P, Lin E, Lawrence E, Easley K . Gastroesophageal reflux disease is associated with an increased rate of acute rejection in lung transplant allografts. Transplant Proc. 2010; 42(7):2702-6. PMC: 3395074. DOI: 10.1016/j.transproceed.2010.05.155. View

Murthy S, Nowicki E, Mason D, Budev M, Nunez A, Thuita L . Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation. J Thorac Cardiovasc Surg. 2011; 142(1):47-52.e3. DOI: 10.1016/j.jtcvs.2011.04.028. View

Hartwig M, Anderson D, Onaitis M, Reddy S, Snyder L, Lin S . Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thorac Surg. 2011; 92(2):462-8. PMC: 3617490. DOI: 10.1016/j.athoracsur.2011.04.035. View

Lucan V, Berardinelli L . Gastrointestinal Side Effects of Post-Transplant Therapy. J Gastrointestin Liver Dis. 2016; 25(3):367-73. DOI: 10.15403/jgld.2014.1121.253.ptt. View

Logan A, Morris-Stiff G, Bowrey D, Jurewicz W . Upper gastrointestinal complications after renal transplantation: a 3-yr sequential study. Clin Transplant. 2002; 16(3):163-7. DOI: 10.1034/j.1399-0012.2002.01012.x. View

Lipson D, Berlin J, Palevsky H, Kotloff R, Tino G, Bavaria J . Giant gastric ulcers and risk factors for gastroduodenal mucosal disease in orthotopic lung transplant patients. Dig Dis Sci. 1998; 43(6):1177-85. DOI: 10.1023/a:1018835219474. View

Lo W, Goldberg H, Boukedes S, Burakoff R, Chan W . Proton Pump Inhibitors Independently Protect Against Early Allograft Injury or Chronic Rejection After Lung Transplantation. Dig Dis Sci. 2017; 63(2):403-410. DOI: 10.1007/s10620-017-4827-0. View

Pegna V, Mickevicius A, Tsang C . How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?. Medicina (Kaunas). 2014; 50(6):318-22. DOI: 10.1016/j.medici.2014.11.006. View

10.

Mertens V, Blondeau K, Vanaudenaerde B, Vos R, Farre R, Pauwels A . Gastric juice from patients "on" acid suppressive therapy can still provoke a significant inflammatory reaction by human bronchial epithelial cells. J Clin Gastroenterol. 2010; 44(10):e230-5. DOI: 10.1097/MCG.0b013e3181d47dc4. View

11.

Abbassi-Ghadi N, Kumar S, Cheung B, McDermott A, Knaggs A, Zacharakis E . 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. J Heart Lung Transplant. 2013; 32(6):588-95. DOI: 10.1016/j.healun.2013.02.009. View

12.

Robertson A, Krishnan A, Ward C, Pearson J, Small T, Corris P . Anti-reflux surgery in lung transplant recipients: outcomes and effects on quality of life. Eur Respir J. 2011; 39(3):691-7. DOI: 10.1183/09031936.00061811. View

13.

Dy F, Freiberger D, Liu E, Boyer D, Visner G, Rosen R . Impact of gastroesophageal reflux and delayed gastric emptying on pediatric lung transplant outcomes. J Heart Lung Transplant. 2017; 36(8):854-861. DOI: 10.1016/j.healun.2017.01.005. View

14.

Leiva-Juarez M, Urso A, Costa J, Stanifer B, Sonett J, Benvenuto L . Fundoplication after lung transplantation in patients with systemic sclerosis-related end-stage lung disease. J Scleroderma Relat Disord. 2022; 6(3):247-255. PMC: 8922666. DOI: 10.1177/23971983211016210. View

15.

Leiva-Juarez M, Benvenuto L, Costa J, Blackett J, Aversa M, Robbins H . Identification of Lung Transplant Recipients With a Survival Benefit After Fundoplication. Ann Thorac Surg. 2021; 113(6):1801-1810. DOI: 10.1016/j.athoracsur.2021.05.098. View

16.

Green C, Gulack B, Keshavjee S, Singer L, McCurry K, Budev M . Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg. 2022; 115(4):1024-1032. DOI: 10.1016/j.athoracsur.2022.09.037. View

17.

Davis Jr R, Lau C, Eubanks S, Messier R, Hadjiliadis D, Steele M . Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation. J Thorac Cardiovasc Surg. 2003; 125(3):533-42. DOI: 10.1067/mtc.2003.166. View

18.

Razia D, Mittal S, Fournier S, Walia R, Smith M, Bremner R . Antireflux surgery versus medical management of gastro-oesophageal reflux after lung transplantation. Eur J Cardiothorac Surg. 2023; 63(3). DOI: 10.1093/ejcts/ezad063. View

19.

Biswas Roy S, Elnahas S, Serrone R, Haworth C, Olson M, Kang P . Early fundoplication is associated with slower decline in lung function after lung transplantation in patients with gastroesophageal reflux disease. J Thorac Cardiovasc Surg. 2018; 155(6):2762-2771.e1. DOI: 10.1016/j.jtcvs.2018.02.009. View