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Reviews

Lung Transplantation, Gastroesophageal Reflux, and Fundoplication

^a Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
^b Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle University, Newcastle, United Kingdom
^c Immunobiology and Transplantation Group, Newcastle University, Newcastle, United Kingdom
^d Institute of Cellular & Molecular Biosciences, Newcastle University, Newcastle, United Kingdom

^_* Address correspondence to Prof Griffin, Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle, NE1 4LP, United Kingdom (Email: michael.griffin{at}nuth.nhs.uk).

Lung transplantation is an accepted treatment strategy for end-stage lung disease; however, bronchiolitis obliterans syndrome is a major cause of morbidity and mortality. This review explores the role of gastroesophageal reflux disease in bronchiolitis obliterans syndrome and the evidence suggesting the benefits of anti-reflux surgery in improving lung function and survival. There is a high prevalence of gastroesophageal reflux in patients post lung transplantation. This may be due to a high preoperative incidence, vagal damage and immunosuppression. Reflux in these patients is associated with a worse outcome, which may be due to micro-aspiration. Anti-reflux surgery is safe in selected lung transplant recipients; however there has been one report of a postoperative mortality. Evidence is conflicting but may suggest a benefit for patients undergoing anti-reflux surgery in terms of lung function and survival; there are no controlled studies. The precise indications, timing, and choice of fundoplication are yet to be defined, and further studies are required.

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