Molina Ezequiel J, Short Scott, Monteiro Glen, Gaughan John P, Macha Mahender
Department of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
Gen Thorac Cardiovasc Surg. 2009 Dec;57(12):647-53. doi: 10.1007/s11748-009-0486-1.
Gastroesophageal reflux disease (GERD) is associated with allograft dysfunction after lung transplantation (LTX). We attempted to identify outcomes in LTX recipients with clinical evidence of GERD.
Retrospective review of 162 LTX recipients at our institution between January 1994 and June 2006 was performed. GERD was confirmed in symptomatic patients by esophagogastroduodenoscopy (EGD) and/or esophagography. Occurrence of biopsy-proven obliterative bronchiolitis (OB) and bronchiolitis obliterans syndrome (BOS) were analyzed. Kaplan-Meier analysis of survival and Cox proportional hazard analysis of risk factors were performed.
GERD was diagnosed in 21 (13%) of patients, usually following LTX (71%). There was no difference in mean survival (1603 +/- 300 vs. 1422 +/- 131 days; log rank P > 0.05), or development of OB (5% vs. 6%, respectively; P > 0.05) in patients with GERD compared with patients without GERD. However, there was correlation between GERD and BOS (P = 0.01).
Symptomatic GERD is increased following LTX. Patients with symptomatic GERD demonstrated an increased incidence of BOS, but survival was not affected in this study. More sensitive and specific diagnostic tools should be implemented in all LTX recipients to investigate the impact of symptomatic and silent GERD and thus improve outcomes after LTX.
胃食管反流病（GERD）与肺移植（LTX）后的移植物功能障碍相关。我们试图确定有GERD临床证据的LTX受者的预后情况。
对1994年1月至2006年6月间在我们机构接受LTX的162例受者进行回顾性研究。有症状的患者通过食管胃十二指肠镜检查（EGD）和/或食管造影确诊GERD。分析经活检证实的闭塞性细支气管炎（OB）和闭塞性细支气管炎综合征（BOS）的发生情况。进行生存的Kaplan-Meier分析和危险因素的Cox比例风险分析。
21例（13%）患者被诊断为GERD，通常在LTX后（71%）。与无GERD的患者相比，GERD患者的平均生存期（分别为1603±300天和1422±131天；对数秩检验P>0.05）或OB的发生情况（分别为5%和6%；P>0.05）无差异。然而，GERD与BOS之间存在相关性（P=0.01）。
LTX后有症状的GERD有所增加。有症状的GERD患者BOS的发生率增加，但本研究中生存期未受影响。应在所有LTX受者中采用更敏感和特异的诊断工具，以研究有症状和无症状GERD的影响，从而改善LTX后的预后。
