Is Dysphagia a Pre-Existing Condition in Individuals Undergoing Lung Transplantation? Radiographic Swallowing Safety Profiles before and after Lung Transplantation

Purpose Breathing and swallowing are basic survival functions that share a common anatomical conduit for the passage of air and food and are governed by shared neural networks and reciprocal peripheral musculature. Individuals with end-stage respiratory disease who are awaiting lung transplantation (LT) are therefore at high risk for dysphagia. Although dysphagia has been reported in high rates in post-operative LT patients, it is currently unclear if dysphagia is a pre-existing condition or rather a complication of surgical and intubation procedures performed. We therefore aimed to compare radiographic swallowing profiles in LT patients before and after LT. Methods A retrospective review of consecutive patients undergoing LT from 2017 and 2020 at a single academic institution was performed. Pre- and post-operative videofluoroscopic swallow study (VFSS) reports were identified and the validated Penetration Aspiration Scale (PAS) was retrieved. Frequencies, independent t-tests and Chi-Square analyses were conducted. Results 166 patients had viable pre- and post-operative VFSS reports that were included. Pre-Operative Dysphagia Status : 83% (PAS ≤2, n=137) demonstrated safe swallowing, 10% (PAS 3-5, n=17) exhibited penetration into the upper airway, and 7% (PAS ≥ 6, n=12) exhibited tracheal aspiration. Aspiration profiles, in rank order, included an ineffective cough response to remove aspirate in 50% (PAS 7, n=6), expulsion of tracheal aspirate 33% (PAS 6, n=4), while 17% demonstrated silent aspiration (PAS 8, n=2). No associations were noted for pre-operative dysphagia and gender, age, BMI, or race (p>0.05). Post-Operative Dysphagia Status: 20% (n=33) demonstrated safe swallowing, 41% (n=68) penetration, while 39% (n=65) exhibited tracheal aspiration. Swallowing safety distribution profiles differed across pre- versus post-operative profile (p=0.02). Conclusion Frequency of unsafe swallowing increased by 4.7 times across pre- and post-operative time points. Further, an ∼six-fold increase in radiographically confirmed tracheal aspiration was observed. Thus, a high rate of incident dysphagia cases was observed, highlighting the need for close post-operative monitoring and identification of contributing risk factors to optimize procedures, patient care and outcomes.