Chest
Clinical InvestigationsTRANSPLANTSLung Transplantation Exacerbates Gastroesophageal Reflux Disease*
Section snippets
Materials and Methods
The transplant population included all patients undergoing lung transplantation at Duke University Medical Center. From 1992 to January 2001, there were 320 lung transplant operations performed. Standardized surgical techniques were used for the operations, and these are described elsewhere.12 Patients generally received postoperative immunosuppression with cyclosporine A (5 to 10 mg/kg/d), azathioprine (1 to 2 mg/kg/d), and corticosteroids (methylprednisolone, 125 mg q12h for the first 48 h,
Results
A total of 23 of 137 patients (16.8%) underwent both pretransplant and posttransplant reflux studies at the time of this analysis. The demographic characteristics of the patient population are displayed in Table 1. The mean patient age was 51.5 years, and a majority of the patients were female and underwent bilateral lung transplantation. Pretransplant studies were performed a median of 66 days prior to transplant (range, 1 to 443 days), and posttransplant studies occurred a median of 100 days
Discussion
Lung transplantation has become an accepted treatment modality for end-stage lung disease, but long-term outcomes remain limited, with 5-year survival at approximately 50%.17 The entity of chronic rejection, which is very common, has been difficult to define, but histologic obliterative bronchiolitis (OB) is considered indicative of chronic allograft rejection.18 The pathogenesis of OB remains poorly understood, though many mechanisms including immunologic, infectious, and perioperative factors
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2021, Journal of Heart and Lung TransplantationCitation Excerpt :Disorders of gastric motility, including gastroesophageal reflux disease (GERD), esophageal dysmotility and gastroparesis are common in patients with advanced lung disease, including those with idiopathic pulmonary fibrosis and connective tissue disorders.100-103 Several studies report the prevalence of gastric motility disorders to increase following lung transplantation101-103 with the incidence of GERD reported to be as high as 75%.29-31 The etiology is often multifactorial, however vagal nerve injury, which may occur during dissection for pneumonectomy or during implantation of the donor lungs, as well as immunosuppressive medication regimes, are considered to be large contributors.104,105
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Supported in part by a clinical research grant from the CF Foundation.
Performed at Duke University Medical Center.