The GERD Effect in Lung Transplants

A study published in the July issue of The Journal of Thoracic and Cardiovascular Surgery by researchers at the Cleveland Clinic found that patients with gastroesophageal reflux disease (GERD) face particular challenges after undergoing lung transplant.

Lung transplant patients with GERD were already known to be at risk for bronchiolitis obliterans (in which small airways in the lungs get inflamed and obstructed), but GERD’s effects on acute rejection of the transplanted lung, function of the newly transplanted lung, and patient survival were unknown, so the study authors set out to investigate them.

The study looked at 114 patients who received a lung transplant between 2005 and 2008, all of whom received preoperative pH testing. Of these, 32 showed evidence of GERD. As measured by forced one-second expiratory volume (FEV₁) the GERD patients demonstrated significantly decreased post-transplant lung function. 18 months after receiving a double lung transplant, FEV₁ was 70% of predicted in GERD patients and 83% of expected in non-GERD patients. For single lung transplants, FEV₁ was 50% of predicted for GERD patients and 60% of expected for non-GERD patients. GERD patients also had a lower survival rate early after transplant (75% vs. 90%), though GERD had no effect on acute rejection of the transplanted lung.

Given the shortcomings in GERD patients’ performance, the study’s authors recommend thorough testing for GERD before performing a lung transplant and aggressive therapy for GERD patients after transplant, potentially including fundoplication, in which part of the stomach is wrapped around the esophagus to block the passage of stomach acids.

Around the Web

Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation [The Journal of Thoracic and Cardiovascular Surgery]