Esophageal Disorders in Lung Transplant Recipients: Association with Chronic Lung Allograft Dysfunction and Survival

Abstract

<h3>Purpose</h3> Chronic lung allograft dysfunction (CLAD) is a major cause of morbidity and mortality in lung transplant recipients and is often triggered by aspiration events, potentiated by esophageal and gastric disorders. The two major classes of esophageal disorders include: 1) disorders of peristalsis and 2) esophagogastric junction outflow obstruction (EGJOO). Previous small studies have shown conflicting relationships between esophageal function and the development of CLAD. Herein, we sought to investigate the relationship between esophageal disorders and long-term outcomes in a large retrospective cohort of lung transplant recipients. <h3>Methods</h3> All lung transplant recipients from 2000-2018 with available esophageal manometry testing within first 7 months post-transplant were included in this study. Subjects were categorized into three groups: 1) no esophageal disorders, 2) disorder of peristalsis, and 3) EGJOO (defined by the 2007 Chicago Classification System). Disorders of peristalsis were further divided into major disorder (absent contractions) and minor disorder (irregular contractions). Univariable Cox proportional hazards models were used to determine the relationship between esophageal disorders and the development of CLAD and allograft failure (death/retransplant). <h3>Results</h3> Of 487 subjects, 47 (10%) had a disorder of peristalsis (8 major, 39 minor) and 57 (12%) had EGJOO. Older subjects were more likely to have an esophageal disorder (p=0.001). A major disorder of peristalsis was associated with an increased risk of CLAD [HR 2.78 (95% CI 1.23-6.28); p=0.01] and allograft failure [HR 3.17 (95% CI 1.49-6.77); p=0.003]. A minor disorder of peristalsis was not significantly associated with CLAD or allograft failure. EGJOO was associated with an increased risk of CLAD [HR 1.63 (95% CI 1.11-2.40); p=0.01] and allograft failure [HR 1.73 (1.18-2.54); p=0.005]. <h3>Conclusion</h3> In a large retrospective cohort we observed that lung transplant recipients with major disorders of peristalsis and EGJOO were at an increased risk of CLAD and death/retransplant. In contrast, people with minor disorders of peristalsis were not at an increased risk of these outcomes. These findings will help with risk-stratification of lung transplant recipients and personalization of treatment for aspiration prevention.