S0436 Pre-Transplant GERD Does Not Predict Post-Lung Transplant Mortality, Acute Rejection, or Chronic Rejection: A 10-Year Retrospective Review

Abstract

INTRODUCTION: The long-term impact of GERD on morbidity and mortality in lung transplant are still unclear. Conflicting evidence exists regarding the importance of pre-transplant GERD and lung transplant outcomes. We had previously found an association between a pre-transplant diagnosis of GERD based on symptoms and increased lung transplant mortality. We therefore hypothesized that pre-transplant GERD as measured by endoscopy and pH criteria is a predictor of mortality and acute and chronic rejection in lung transplant patients. METHODS: In a single-center retrospective 10-year cohort study, we analyzed all patients who underwent lung transplantation from 2009-2019. Time-to-event analysis using Cox proportional hazards model was utilized for mortality, acute rejection by biopsy, and the development of chronic lung allograft dysfunction (CLAD), testing pre-transplant GERD as a predictor for the above adjusted for age, gender, BMI, and transplant status (single vs. double lung). Pre-transplant GERD was defined based on DeMeester score, evidence of Barrett’s esophagus, peptic strictures, or esophagitis. RESULTS: 227 patients who underwent lung transplantation (30% IPF, 26% COPD, 19% CF) were analyzed in this study. 72 patients underwent pre-transplant reflux testing. 55.8% (n = 39) of those tested met our criteria for GERD. Among all patients, 28.2% (n = 64) experienced the outcome of death. 62.5% (n = 15) had a pre-transplant diagnosis of GERD among those who died and who underwent pre-transplant testing. In a time to event analysis, GERD was not found to be predictive of time to death, time to acute rejection by biopsy (not shown), or time to the development of CLAD (Figures 1 and 2). GERD was negatively predicted by the presence of gastroparesis with 8 patients in the non-GERD group having gastroparesis compared to 0 in the GERD group (Table 1). DISCUSSION: In a 10-year single-center retrospective follow-up study, no association was found between a pre-transplant diagnosis of GERD based on testing and lung transplant mortality, acute rejection, or CLAD. One potential predictive variable of death and rejection, independent of GERD, was gastroparesis. Overall, early identification and management of GERD as per our routine practice shows that pre-transplant GERD diagnosis does not worsen post-transplant outcomes. Prospective studies on dose of acid suppression, timing of anti-reflux surgeries, and uniform standards of pre-transplant evaluation are needed.Figure 1.: GERD as a Risk Factor for Mortality.Figure 2.: GERD as a Risk Factor for CLAD.Table 1.: Patient Characteristics by GERD