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Right arrow Lung - transplantation

Ann Thorac Surg 2004;78:1142-1151
© 2004 The Society of Thoracic Surgeons

J. Maxwell Chamberlain Memorial Paper

Early Fundoplication Prevents Chronic Allograft Dysfunction in Patients with Gastroesophageal Reflux Disease

Edward Cantu, III, MDa,*, James Z. Appel, III, MDa, Matthew G. Hartwig, MDa, Hiwot Woreta, BAa, Cindy Green, PhDc, Robert Messier, MD, PhDa, Scott M. Palmer, MD, MPHb,c, R. Duane Davis, Jr, MDa

a Department of Surgery, Duke University Medical Center, Durham, NC, USA,
b Department of Medicine, Duke University Medical Center, Durham, NC, USA;
c Duke Clinical Research Institute, Durham, North Carolina, USA

Accepted for publication April 12, 2004.

* Address reprint requests to Dr Davis, Department of Surgery, Duke University Medical Center, Box 3864, Durham, NC 27710, USA
davis053{at}mc.duke.edu

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

Abstract

BACKGROUND: Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival.

METHODS: A retrospective analysis of 457 patients who underwent lung transplantation from April 1992 through July 2003 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (< 90 days) fundoplication and history of reflux and late fundoplication.

RESULTS: Incidence of postoperative reflux was 76% (127 of 167 patients) in pH confirmed subgroups. In 14 patients with early fundoplication, actuarial survival was 100% at 1 and 3 years when compared with those with reflux and no intervention (92% ± 3.3, 76% ± 5.8; p < 0.02). Further, those who underwent early fundoplication had improved freedom from bronchiolitis obliterans syndrome at 1 and 3 years (100%, 100%) when compared with no fundoplication in patients with reflux (96% ± 2.5, 60% ± 7.5; p < 0.01).

CONCLUSIONS: Reflux is a frequent medical complication after lung transplantation. Although the number of patients undergoing early fundoplication is small, our results suggest early aggressive surgical treatment of reflux results in improved rates of bronchiolitis obliterans syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.




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