Feeling the Burn: Esophageal PH and CLAD

Abstract

<h3>Purpose</h3> After lung transplantation, there is an association between chronic allograft dysfunction and pre-transplant esophageal dysfunction. While many centers perform esophageal pH monitoring as part of the pre-transplantation workup, it is unclear whether this evaluation needs to be performed prior to transplant for all patients. We aim to evaluate the relationship between pre-transplant esophageal pH studies and the incidence of chronic lung allograft dysfunction (CLAD). <h3>Methods</h3> A retrospective cohort study was conducted in a single lung transplant center. Patients who underwent single or bilateral lung transplantation between January 2016 and September 2020 were included. Patient demographics, pre-transplant esophageal pH studies, and post-transplant spirometry data were collected. CLAD was defined using the 2019 ISHLT Consensus report. Esophageal pH studies were analyzed using the DeMeester score, and a value > 14.72 was considered abnormal. <h3>Results</h3> A total of 84 patients were evaluated; 67 were included for analysis. The median age at transplant was 66 years (58 - 70 years, IQR). 49.3% of patients were female (n=33), and median BMI was 25.02. The median follow-up was 856 days. A total of 21 patients (31.3%) developed CLAD. The median DeMeester Score was 11.7, and 30 patients were found to have an abnormal DeMeester score. Pre-transplant DeMeester scores did not vary significantly between patients with and without CLAD (22.7 vs. 11.0 respectively, p=0.42). The average time until CLAD development was not statistically different between those with normal and abnormal DeMeester scores (665.0 days vs. 484.4 days respectively, p=0.18). After adjusting for age, BMI and gender, those with abnormal DeMeester scores did not have a higher odds of developing CLAD (OR 1.42, p=0.53). <h3>Conclusion</h3> There was no significant association between abnormal DeMeester studies and the development of CLAD, or the timing of CLAD onset. Further studies should evaluate the impact of a protocol of only evaluating clinically significant GERD as part of the pre-transplant evaluation.