Background
The primary aim of this study was to determine if allograft function in lung transplant
(LTx) recipients improves or stabilizes after laparoscopic fundoplication (LF). The
secondary aim was to examine the differences in forced expiratory volume in 1 second
(FEV1) before and after LF for various subgroups to identify patients who obtained
a superior respiratory outcome after LF, and potential predictive factors for this
outcome.
Methods
Retrospective analysis of consecutive LTx recipients undergoing LF at a single centre
in Brisbane, Australia between 2004 and 2018. 149/431 proceeded to LF after clinical
review and pH study. Regular pre- and post-fundoplication pulmonary function tests
were collected from participants. Data were analyzed with linear mixed models, random
intercept models, the Reliable Change Index (RCI), and graphical and visual analysis
of the trajectory of FEV1.
Results
There was 100% follow-up. After Bonferroni adjustment for multiple comparison was
performed, none of the models demonstrated statistical significance. The Reliable
Change Index showed one patient had a significant improvement in lung function across
that time period, while nine had a significant reduction. The rate of change before
and after LF was similar for the 132/149 patients for whom the first and last pre-
and post-LF FEV1 values were available. A subset of patients had a considerable reduction
in their FEV1 in the peri-operative period (i.e., a large difference between the first
measurement post-LF and the final measurement pre-LF).
Conclusion
In the largest published cohort to date, LF performed in a high-volume center did
not appear to alter the reduction in allograft function seen with time.
KEYWORDS
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References
- Obliterative bronchiolitis.Transplantation. 2016; 100: 272-283
- Chronic Lung Allograft Dysfunction: Phenotypes and the Future. Essentials in Lung Transplantation.Springer, 2019: 119-129
- Lung transplantation exacerbates gastroesophageal reflux disease.Chest. 2003; 124: 1689-1693
- Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation.J Thorac Cardiovasc Surg. 2005; 129: 1144-1152
- Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection.Eur Respir J. 2008; 31: 707-713
- Oil red O stain of alveolar macrophages is an effective screening test for gastroesophageal reflux disease in lung transplant recipients.J Heart Lung Transplantation Official Publication Int Soc. Heart Transplantation. 2010; 29: 859-864
- Importance of chronic aspiration in recipients of heart-lung transplants.Lancet. 1990; 336: 206-208
- Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation.Chest. 2000; 118: 1214-1217
- Commentary: The burning questions of reflux management in lung transplantation.J Thorac Cardiovasc Surg. 2020; 160: 869-870
- Fundoplication to preserve allograft function after lung transplant: Systematic review and meta-analysis.J Thorac Cardiovasc Surg. 2020; 160: 858-866
- An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome.Eur Respir J. 2014; 44: 1479-1503
- Partial Fundoplications (270° Toupet, 90° Dor).Foregut: J Am Foregut Soc. 2021; 1: 182-184
- Standardization of spirometry 2019 update. an official american thoracic society and european respiratory society technical statement.Am J Respir Crit Care Med. 2019; 200: e70-e88
Council NHaMR. Ethical considerations in quality assurance and evaluation activities. 2014. Australian Government (https://www.nhmrc.gov.au/about-us/resources/ethical-considerations-quality-assurance-and-evaluation-activities).
- Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.J Consult Clin Psychol. 1991; 59: 12
- The reliable change index: why isn't it more popular in academic psychology.Psychology Postgraduate Affairs Group Quarterly. 2010; 76: 14-19
- An interrater reliability study of pulmonary function assessment with a portable spirometer.Respir Care. 2020; 65: 665-672
- Survival in adult lung transplantation: where are we in 2020?.Curr Opin Organ Transplant. 2020; 25: 268-273
Authority AGOaT. 2020 deceased organ donation and transplantation. 2021. Australian Government.
- The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult lung transplantation report — 2021; focus on recipient characteristics.J Heart Lung Transplant. 2021; 40: 1060-1072
- Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplantation Official Publication Int Soc Heart Transplantation. 2019; 38: 493-503
- Validation of a post-transplant chronic lung allograft dysfunction classification system.J Heart Lung Transplantation Official Publication Int Soc Heart Transplantation. 2019; 38: 166-173
- 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: 2762-2771
- Commentary: The heartburn of lung transplantation.J Thorac Cardiovasc Surg. 2020; 160: 867
- Proton pump inhibitors independently protect against early allograft injury or chronic rejection after lung transplantation.Dig Dis Sci. 2018; 63: 403-410
- Timely medical or surgical anti-reflux treatment as directed by pre-transplant reflux testing reduces chronic rejection after lung transplantation.Gastroenterology. 2017; 152: S62-SS.
- Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux.Ann Thorac Surg. 2011; 92: 462-468
- J. Maxwell chamberlain memorial paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.Ann Thorac Surg. 2004; 78: 1142-1151
- Post-Lung transplant esophageal impedance/pH studies do not predict onset of RAS or BOS phenotypes.J Heart Lung Transplant. 2017; 36 (S159-S)
Article info
Publication history
Published online: December 05, 2022
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