Fundoplication to preserve allograft function after lung transplant: Systematic Review and Meta-Analysis

Abstract Objective This review and pooled analysis sought to demonstrate objective evidence of improved graft function in lung transplant patients undergoing anti-reflux surgery (ARS). Summary Background DataARS has been adopted in select patients with lung transplant for the past two decades across many centers. Outcomes have been reported sporadically; as retrospective series and no pooled analysis has been performed. Methods In accordance with MOOSE guidelines, a search of PubMed Central, Medline, Google Scholar and Cochrane Library databases was performed. Papers documenting; spirometry data pre- and post-ARS were reviewed and a random-effects model meta-analysis was performed on FEV1 values and the rate of change of FEV1. Results 6 papers were included in the meta-analysis. Regarding FEV1 before and after ARS, we observed a small increase in FEV1 values in studies reporting raw values in L/1sec (2.02+/-0.89 vs. 2.14+/-0.77, n=154) and % of predicted (77.1+/-22.1 vs. 81.2+/-26.95, n=45), with a 'small' pooled Cohen's d effect size of 0.159(p=0.114). When considering the rate of change of FEV1 (ml/day) we observed a significant difference in pre-ARS compared; to post-ARS (-2.12 +/- 2.76 ml/day vs. +0.05+/-1.19, n=103). There was a pooled effect size; of 1.702(p=0.013), a "large" effect of ARS on the rate of change of FEV1 values. Conclusions This meta-analysis of retrospective observational studies demonstrates that ARS might benefit patients with declining FEV1 examining the rate of change of FEV1 in the pre- and post-operative periods.