Abstract
Purpose Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation (LTx) and has been associated with allograft injury and chronic lung allograft dysfunction (CLAD) presumably through chronic microaspiration of bile acids and other gastric contents with subsequent innate immune activation. Anti-reflux surgery is widely used at some centers to treat GERD in LTx; however, its role in inflammation or aspiration is unknown. Our objective was to examine the effects of early anti-GERD surgery in LTx recipients on markers of microaspiration and inflammation in the bronchoalveolar lavage (BAL). Methods We identified 18 LTx recipients who underwent Nissen fundoplication within 6 months post LTx and who had BAL samples obtained within 3 months pre- and post-Nissen. BAL levels of IL-6, IL-8, S100A8, S100A12, CCL2, IL-1α, IL-1β, CCL5, sRAGE, and IL-12p70 were measured by multiplex assay. BAL levels of 3 most prevalent bile acids−cholic acid (CA), taurocholic acid (TCA), and glycocholic acid (GCA)−were measured by mass spectrometry. Values pre- and post-Nissen were compared using the paired Wilcoxon signed-rank test . Generalized Estimating Equation models were used to adjust for concurrent rejection, infection, and their treatment. Results IL-8, S100A8, IL-1α, IL-1β, CCL5, IL-12p70, and TCA were significantly reduced post-Nissen compared to pre-Nissen after adjustment (Figure 1). Other cytokines and bile acids were not significantly different between pre- and post-Nissen. However, most bile acid levels were very low; some patients had elevated bile acid levels pre-Nissen, which did not remain elevated post-Nissen. Conclusion Early anti-GERD surgery in LTx recipients is associated with a significant decrease in lung inflammation and may also decrease markers of microaspiration. Further studies are warranted to determine whether anti-reflux surgery can prevent allograft injury and CLAD in patients at risk.
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