Green Cynthia L, Gulack Brian C, Keshavjee Shaf, Singer Lianne G, McCurry Kenneth, Budev Marie M, Reece Tammy L, Lidor Anne O, Palmer Scott M, Davis R Duane
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2023 Apr;115(4):1024-1032. doi: 10.1016/j.athoracsur.2022.09.037. Epub 2022 Oct 7.
Aspiration has been associated with graft dysfunction after lung transplantation, leading some to advocate for selective use of fundoplication despite minimal data supporting this practice.
We performed a multicenter retrospective study at 4 academic lung transplant centers to determine the association of gastroesophageal reflux disease and fundoplication with bronchiolitis obliterans syndrome and survival using Cox multivariable regression.
Of 542 patients, 136 (25.1%) underwent fundoplication; 99 (18%) were found to have reflux disease without undergoing fundoplication. Blanking the first year after transplantation, fundoplication was not associated with a benefit regarding freedom from bronchiolitis obliterans syndrome (hazard ratio [HR], 0.93; 95% CI, 0.58-1.49) or death (HR, 0.97; 95% CI, 0.47-1.99) compared with reflux disease without fundoplication. However, a time-dependent adjusted analysis found a slight decrease in mortality (HR, 0.59; 95% CI, 0.28-1.23; P = .157), bronchiolitis obliterans syndrome (HR, 0.68; 95% CI, 0.42-1.11; P = .126), and combined bronchiolitis obliterans syndrome or death (HR, 0.66; 95% CI, 0.42-1.04; P = .073) in the fundoplication group compared with the gastroesophageal reflux disease group.
Although a statistically significant benefit from fundoplication was not determined because of limited sample size, follow-up, and potential for selection bias, a randomized, prospective study is still warranted.
肺移植后误吸与移植肺功能障碍相关，这使得一些人主张选择性使用胃底折叠术，尽管支持这种做法的数据极少。
我们在4个学术性肺移植中心进行了一项多中心回顾性研究，使用Cox多变量回归来确定胃食管反流病和胃底折叠术与闭塞性细支气管炎综合征及生存率之间的关联。
在542例患者中，136例（25.1%）接受了胃底折叠术；99例（18%）未接受胃底折叠术但被发现患有反流病。排除移植后的第一年，与未接受胃底折叠术的反流病相比，胃底折叠术在预防闭塞性细支气管炎综合征（风险比[HR]，0.93；95%置信区间[CI]，0.58 - 1.49）或死亡（HR，0.97；95% CI，0.47 - 1.99）方面并无益处。然而，一项时间依赖性调整分析发现，与胃食管反流病组相比，胃底折叠术组的死亡率（HR，0.59；95% CI，0.28 - 1.23；P = 0.157）、闭塞性细支气管炎综合征（HR，0.68；95% CI，0.42 - 1.11；P = 0.126）以及闭塞性细支气管炎综合征或死亡合并症（HR，0.66；95% CI，0.42 - 1.04；P = 0.073）略有下降。
尽管由于样本量有限、随访时间有限以及存在选择偏倚的可能性，胃底折叠术的统计学显著益处尚未确定，但仍有必要进行一项随机前瞻性研究。
