Gastroesophageal Reflux in Lung Transplantation

Abstract

Gastroesophageal reflux disease (GERD) in lung transplant recipients has been associated with chronic lung allograft dysfunction (CLAD). CLAD is a leading cause of mortality in lung transplant recipients, and it is probably the result of a variety of immune, infectious, and inflammatory injuries. GERD may contribute to CLAD since it is associated with a higher risk for post-transplant aspiration. Aspiration induces an inflammatory cascade in the lung allograft, thereby causing acute rejection. Recurrent episodes of acute rejection and allograft injury may then contribute to chronic rejection, resulting in graft failure. Poorer outcomes after transplantation, including early allograft injury, early rehospitalization, and chronic rejection are potentially modifiable risk factors for post-transplant mortality. In patients with GERD, antireflux surgery may help preserve post-transplant lung function, improve immune response, and reduce the incidence of bronchiolitis obliterans syndrome and mortality. Early fundoplication improves survival and reduces the incidence of CLAD in lung transplant recipients.

Keywords

• Antireflux surgery. Chronic lung allograft dysfunction. Fundoplication. Gastroesophageal reflux disease. Lung transplantation.