Gastroparesis after Lung Transplantation is Common but Not Associated with Inferior Outcomes

Abstract

Purpose Gastroparesis (GP) affects 23-91% lung transplant (LT) recipients and may be associated with increased gastro-oesophageal reflux disease (GORD), an established risk factor for Chronic Lung Allograft Dysfunction (CLAD). The temporal association between GP, CLAD and GORD remains unclear. This study assessed whether patients with GP post LT experienced more GORD, CLAD and inferior nutrition-related outcomes. Methods Single centre retrospective review of adult LT recipients between January 2015 and December 2018 was conducted. GP was identified by either abnormal Gastric emptying studies (GES) or significant food residue retained within the stomach on upper endoscopy. GES were performed on patients symptomatic for gastroparesis - bloating, early satiety, nausea. Reflux was diagnosed via routine performance of 24-hour pH studies on all patients irrespective of symptoms, from 3 months post LT. Outcome variables included demographics, diagnosis of CLAD, survival at 3, 12 months, surgery duration, fundoplication pre and post LT, presence of GORD and weight trajectory post LT. Presence of GP was compared to the above variables. Results 149 patients were analysed; 27.5% (n=41) had GP, diagnosed through GE study (n=33), or Endoscopy (n=8). There was no association between GP and GORD (p=0.265), CLAD (p=0.529), 3-month (p=0.621), or 12-month (p=0.645) survival. GP was associated with an increased BMI, both as a continuous and categorical variable (BMI: 25.0 SD 4.6 vs 23.3 SD 3.9 kg/m2, p=0.030), and patients with GP were more likely to have unintentional weight loss at 6 weeks (GP: -6.2 ± 5.7%, 95% CI -4.4 to -8.1 vs. no GP: -1.7 ± 5.8%, 95% CI -3 to -0.56; p Conclusion Patients with gastroparesis post LT did not have worse short-term survival, GORD or CLAD outcomes. They were, however, more likely to experience unintentional weight loss. Intensive Dietetic input post LT is required in patients identified with GP to prevent malnutrition.