de Pablo Alicia, Alonso Rodrigo, Ciriza Constanza, Lopez Eloisa, Canga Fernando, Juarros Lourdes, Gamez Pablo, Perez Virginia
Pneumology Unit, University Hospital 12 de Octubre, Madrid, Spain; Center of Net Biomedical Investigation on Respiratory Diseases (CIBERES), Madrid, Spain.
Pneumology Unit, University Hospital 12 de Octubre, Madrid, Spain; Center of Net Biomedical Investigation on Respiratory Diseases (CIBERES), Madrid, Spain.
Transplant Proc. 2021 Jul-Aug;53(6):1989-1997. doi: 10.1016/j.transproceed.2021.03.035. Epub 2021 May 14.
Esophageal pathology has been identified as a bad prognostic factor in lung transplantation (LTx). This study aims to assess the esophageal disorders present post-LTx, under treatment with proton pump inhibitors, and their putative impact on the graft.
Prospective, observational study of LTx patients. Digestive factors were assessed by manometry and pH-metry at 6 months post-LTx and under proton pump inhibitor treatment. We assessed the association between esophageal disorders and graft function and acute rejection (AR) and chronic lung allograft dysfunction (CLAD).
Out of 76 post-LTx patients, 27% showed gastroesophageal reflux disease (GERD), 55% showed inadequate gastric inhibition, and 59% showed esophageal motility disorders (EMDs). We observed a greater incidence of AR from 3 months post-LTx in the presence of EMD (P ≤ .05). No significant differences were observed in GERD or EMD prevalence or in survival between patients with or without CLAD. The maximum forced expiratory volume in 1 second (FEV1) achieved after bilateral LTx was significantly (P = .022) lower in patients with EMD vs without EMD.
At 6 months post-LTx, there is a high percentage of esophageal disorders (GERD and EMDs). No esophageal disorder is associated with CLAD or with survival, although EMDs are associated with a greater incidence of AR and lower graft function.
食管病变已被确定为肺移植（LTx）的不良预后因素。本研究旨在评估LTx术后接受质子泵抑制剂治疗时出现的食管疾病及其对移植物的潜在影响。
对LTx患者进行前瞻性观察研究。在LTx术后6个月且接受质子泵抑制剂治疗时，通过测压法和pH测量法评估消化因素。我们评估了食管疾病与移植物功能、急性排斥反应（AR）和慢性肺移植功能障碍（CLAD）之间的关联。
在76例LTx术后患者中，27%表现为胃食管反流病（GERD），55%表现为胃抑制不足，59%表现为食管动力障碍（EMD）。我们观察到在存在EMD的情况下，LTx术后3个月起AR的发生率更高（P≤0.05）。在有或无CLAD的患者之间，GERD或EMD的患病率或生存率均未观察到显著差异。与无EMD的患者相比，有EMD的患者双侧LTx后达到的1秒用力呼气量（FEV1）显著更低（P = 0.022）。
LTx术后6个月时，食管疾病（GERD和EMD）的发生率很高。尽管EMD与更高的AR发生率和更低的移植物功能相关，但没有食管疾病与CLAD或生存率相关。
