The Effect of Esophageal Dysmotility on Lung Transplant Outcomes

Abstract

Reflux is a risk factor for chronic lung allograft dysfunction (CLAD), and lung transplant candidates routinely undergo pH and manometry testing. While management of reflux is established, esophageal motility disorders are frequently detected, and their role in the development of CLAD is unclear. This report investigates the effect of esophageal motility disorders on CLAD after lung transplantation. We hypothesized that esophageal dysmotility will result in more frequent development of CLAD. We performed a retrospective review of all patients who underwent lung transplantation between March 2011 and December 2018 (n=71). We excluded patients with fewer than 6 months follow up. Abnormal manometry studies were grouped using the Chicago Classification of esophageal motility v3.0. Serial pulmonary function tests were followed for detection of obstructive CLAD. 57 patients met inclusion criteria with a mean follow up of 29.6 months. 29 (50.9%) had abnormal esophageal motility: 3 (10.3%) had esophagogastric junction outlet obstruction (EGJOO), 4 (13.8%) had major peristaltic disorders, and 21 (72.4%) had minor peristaltic disorders. CLAD developed in 25% in patients with normal motility versus 31% in those with abnormal motility (p=0.71). There was no difference in the incidence of CLAD among patients with different motility disorders. No difference in FEV1 improvement was seen between patients with normal motility and peristaltic disorders (p = 0.42). A significant decrease was seen in those with EGJOO when compared to those with normal motility (p=0.01) or peristaltic disorders (p = 0.04). Esophageal motility disorders are common in lung transplant candidates. This report suggests that esophageal dysmotility is not associated with development of CLAD. Nevertheless, manometry can detect motility disorders such as EGJOO, which may affect FEV1 recovery after lung transplantation.