Association between Esophageal Dysmotility and Long-Term Outcomes in Lung Transplant Recipients

Abstract

Esophageal dysmotility is very common in lung transplant recipients and is thought to predispose to allograft injury through higher risk of aspiration. At our center, we routinely test lung transplant recipients for esophageal dysmotility with High Resolution Manometry (HRM) at 3 months post-transplant. We hypothesize that lung transplant recipients (LTRs) with significant esophageal dysmotility are more likely to develop lung injury leading to CLAD and death. Among 1753 LTRs transplanted at our center between July 2000 and June 2018, we retrospectively analyzed 426 patients who had HRM with a 24 hour-pH impedance study available post-transplantation. Esophageal hypomotility was defined as >=30% of failed and/or simultaneous esophageal contractions, while esophageal hypermotility was defined as evidence of higher amplitude on HRM. Cox proportional hazards models adjusted for age, sex, native lung disease, CMV matching, and transplant type (single vs double) were used to determine the association between esophageal dysmotility and death/retransplant or CLAD. Esophageal hypomotility and hypermotility was found in 120 (28%) and 22 (5%) patients, respectively. Mild, moderate, and severe hypomotility was found in 58 (48%), 14 (12%), and 48 (40%) patients, respectively. In multivariate analyses, esophageal hypermotility or hypomotility was not associated with CLAD (HR 0.59 [95% CI 0.21-1.60]; HR 0.79 [95% CI 0.52-1.19]). or death (HR 0.53 [95% CI 0.16-1.68]; HR 0.62 [95% CI 0.37-1.03]). The risk of CLAD or death did not vary by severity of hypomotility. In a large single-center lung transplant cohort study, we have determined that esophageal dysmotility is not associated with CLAD or death. Concurrent GI co-morbidities, such as reflux and gastroparesis, may play a role in modifying this risk. Additionally, center-specific approaches to patient selection and/or treatment may be related to outcomes and will be further assessed in future studies.