Baxter Smith, Salwa Gautama, Julie Playfair, Kalai Shaw, Greg Snell, Glen Westall, Wendy Brown, Paul Burton
Anti-reflux surgery (ARS) has previously been suggested to be associated with improvement in lung function outcomes for lung transplant recipients. ARS is proposed to prevent the reflux of gastric contents into the airway and thus prevent the development of bronchiolitis obliterans syndrome (BOS), a key component of chronic lung allograft dysfunction (CLAD). Percent predicted FEV1 (%FEV1) is an established surrogate marker for the measurement of BOS and is used to determine severity of CLAD from grade 0 to 4.
To determine the benefit of anti-reflux surgery in the prevention of CLAD in lung transplant recipients.
Patients were identified from the prospectively maintained Alfred Hospital oesophago-gastric database who had undergone both lung transplantation and subsequently underwent anti-reflux surgery between April 2003 and March 2018. Pre-operative and post-operative lung functions test (LFT) results, symptoms, and use of anti-reflux medication was then compared.
Fifty-four patients (34 males) with a mean age of 45 years underwent laparoscopic fundoplication after lung transplantation with LFT performed 6 months prior, 6 months post, and 12 months post. The mean %predicted FEV1 was 72% and Mean CLAD grade was 0.86, mean time to surgery from lung transplantation was 29 months (range 2 months to 16.5 years). Patients experienced a significant improvement in reflux symptoms (P=<0.0001) and decrease in PPI & H2 receptor antagonist use (P=0.0059 & 0.0001 respectively). Comparing 6 months pre-operatively to 6 months post-operatively there was no significant difference in %predicted FEV1 (Mean %predicted FEV1 72.3% vs 72.06% P=0.8514) or CLAD grade (Mean 0.89 vs 0.92 P=0.7258).
Anti-reflux surgery is associated with improvement in reflux symptoms but is not associated with improved lung function in lung transplant recipients.