Assessing Oropharyngeal Dysphagia After Lung Transplantation: Altered Swallowing Mechanisms and Increased Morbidity

doi:10.1016/j.healun.2007.07.038

The Journal of Heart and Lung Transplantation

Volume 26, Issue 11, November 2007, Pages 1144-1148

https://doi.org/10.1016/j.healun.2007.07.038 Get rights and content

Background

Gastroesophageal reflux is associated with lung transplantation (LT) and bronchiolitis obliterans syndrome, limiting allograft functional longevity. LT patients may also develop post-operative oropharyngeal dysphagia, exposing the allograft to further risk. However, the magnitude of this problem is unknown. We examined LT recipients post-operatively for swallowing disorders and correlated findings with pre- and post-operative variables.

Methods

Two hundred sixty-three LT patients (January 2001 to July 2005) at a single center were retrospectively reviewed. Each underwent clinical swallowing assessment. Provocative swallowing evaluation (SE) was performed in 149 patients (Group 1); 114 patients did not receive formal SE (Group 2). SE studies were considered positive with laryngeal penetration (PEN) or tracheal aspiration (ASP) of thin liquids. Groups were compared with respect to pre-, peri- and post-operative variables using analysis of variance (ANOVA) and chi-square tests.

Results

After LT, 56.7% of patients underwent post-operative SE (mean 19 ± 20 days), most of whom (87.9%) had fiber-optic endoscopic studies. SE was positive for PEN or ASP in 70.5% (n = 105). Aspiration occurred in 63.8% (n = 67) of positive SEs; 77.6% (n = 52) of ASP assessments were clinically silent. Pre-operative gastroesophageal reflux disease (GERD) and post-operative complications, including vocal cord paresis, pleural processes, venous thromboses and severe rejection episodes, were more common among Group 1. Group 2 had a significantly reduced hospital length of stay (p = 0.004).

Conclusions

Prospective SE identified strikingly high rates of dysphagia after LT. Because many of these deficits are silent, aggressive pulmonary toilet is especially important after post-operative LT. Pre-operative SE may clarify those at increased risk for new-onset oropharyngeal dysphagia after LT.

Section snippets

Methods

After local institutional review board approval waiving individual patient consent due to the retrospective study nature, a retrospective review of 263 consecutive lung transplantation patients was undertaken. Patients were treated at a single center between January 2001 and July 2005. Pre-operative demographic data and peri- and post-operative details were recorded for each patient.

Speech pathology consultation was obtained in all patients post-operatively after LT and involved, at a minimum,

Results

Two hundred sixty-three patients underwent LT during the study period. Over 97.3% underwent bilateral LT and did not differ between groups. Ten patients (3.8%) underwent re-do LT. Underlying clinical diagnoses precipitating LT are shown in Figure 2.

Pre-operative and demographic data are shown in Table 1. The two groups analyzed were well matched with regard to age, percent males and history of prior thoracic surgery. However, Group 1 had a significantly higher rate of pre-operative GERD, as

Discussion

Previous work has demonstrated a strong correlation between GERD and lung allograft injury in the form of BOS.1, 3, 4 We hypothesized that repetitive microaspiration events are a contributing factor in lung allograft dysfunction, and recent data from other groups corroborate these assumptions.5, 13 In the present study, we have quantified the prevalence of new-onset oropharyngeal dysphagia and the attendant tracheal aspiration of thin liquids among patients who underwent formal swallowing

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These findings suggest that establishing a comprehensive best practice protocol to avoid postoperative complications, such as aspiration pneumonia, is therefore essential for lung transplant patients. Our findings regarding prevalence of laryngeal penetration and aspiration due to oropharyngeal dysphagia in lung transplant patients are consistent with the previous work of Atkins and co-workers [17]. They retrospectively studied 263 lung transplant recipients.
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Clinical lung and heart/lung transplantationAssessing Oropharyngeal Dysphagia After Lung Transplantation: Altered Swallowing Mechanisms and Increased Morbidity

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Thorac Cardiovasc Surg

Chest

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Heart Lung Transplant

Chest

Auris Nasus Larynx

J Thorac Cardiovasc Surg

Otolaryngol Head Neck Surg

Otolaryngol Head Neck Surg

Am J Gastroenterol

Ann Thorac Surg

J Heart Lung Transplant

Clinical lung and heart/lung transplantation
Assessing Oropharyngeal Dysphagia After Lung Transplantation: Altered Swallowing Mechanisms and Increased Morbidity