IDDF2019-ABS-0304 Gastroesophageal reflux disease and chronic graft failure in lung transplantation: keep the target in sight

Background Gastroesophageal reflux disease (GERD) has been reported in up to 88% of patients after lung transplantation (LTx). Concern has been raised on the aspiration of refluxate which contributed to the nonalloimmune cause for the development of chronic lung allograft failure (CLAD), such as bronchiolitis obliterans syndrome (BOS). This study included a comprehensive review of the current literature on the association of CLAD/BOS and GERD by discussing the pathophysiology, evaluation, and management of GERD. Methods Patient data included age, sex, body mass index, donor and recipient cytomegalovirus immune status, indication for LTx, clinical test data, LTx date, intraoperative data, post-LTx medication, post-LTx complications, including acute rejection, CLAD occurrence, and death and anti-reflux therapy were recorded. Results Publications from PubMed, Scopus and Web of Science on ”lung transplantation, gastroesophageal reflux” were reviewed and analyzed. Cases from our center were reviewed and summarized. Common associations of reflux and transplanted lung status were illustrated by: hazard ratio of reflux on time to development of BOS, effect of reflux on FEV1, relationship between prevalence and extent of GERD and types of transplant; association between the prevalence and type of reflux and gastric aspiration in patients with and without BOS; quantification of reflux, aspiration, and allograft injury. Post-lung transplant exposure to persistent PPI therapy had a beneficial effect. Exposure to severe acid reflux pretransplant was associated with early readmission following lung transplantation in need of aggressive early antireflux therapy. For pediatric recipients, gastric dysmotility related to allograft dysfunction. Bronchoalveolar lavage fluid (BALF) is another useful tool for the current study in LTx patients. There have been shown relationships of levels of bile acids, IL-8, neutrophils on the development of BOS; aspiration on immune mediator concentrations related to BOS; acid exposure, volume exposure, or reflux events correlated to and neutrophilia, bile acids and other dysregulation of immune mediator concentrations; the level of pepsin related to acute rejection. Conclusions Our review of the literature and preliminary data supports that GERD related to lung allograft injury and long-term failure, encouraging a strategy of early diagnosis and aggressive reflux management, aiming to prolong the duration of normal graft function.