Ramendra Rayoun, Fernández-Castillo Juan C, Huszti Ella, Ghany Rasheed, Aversa Meghan, Havlin Jan, Riddell Peter, Chaparro Cecilia M, Singer Lianne G, Liu Louis, Keshavjee Shaf, Yeung Jonathan C, Martinu Tereza
Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
ERJ Open Res. 2023 Sep 10;9(5). doi: 10.1183/23120541.00222-2023. eCollection 2023 Sep.
Morbidity and mortality in lung transplant recipients are often triggered by recurrent aspiration events, potentiated by oesophageal and gastric disorders. Previous small studies have shown conflicting associations between oesophageal function and the development of chronic lung allograft dysfunction (CLAD). Herein, we sought to investigate the relationship between oesophageal motility disorders and long-term outcomes in a large retrospective cohort of lung transplant recipients.
All lung transplant recipients at the Toronto Lung Transplant Program from 2012 to 2018 with available oesophageal manometry testing within the first 7 months post-transplant were included in this study. Patients were categorised according to the Chicago Classification of oesophageal disorders (v3.0). Associations between oesophageal motility disorders with the development of CLAD and allograft failure (defined as death or re-transplantation) were assessed.
Of 487 patients, 57 (12%) had oesophagogastric junction outflow obstruction (OGJOO) and 47 (10%) had a disorder of peristalsis (eight major, 39 minor). In a multivariable analysis, OGJOO was associated with an increased risk of CLAD (HR 1.71, 95% CI 1.15-2.55, p=0.008) and allograft failure (HR 1.69, 95% CI 1.13-2.53, p=0.01). Major disorders of peristalsis were associated with an increased risk of CLAD (HR 1.55, 95% CI 1.01-2.37, p=0.04) and allograft failure (HR 3.33, 95% CI 1.53-7.25, p=0.002). Minor disorders of peristalsis were not significantly associated with CLAD or allograft failure.
Lung transplant recipients with oesophageal stasis characterised by OGJOO or major disorders of peristalsis were at an increased risk of adverse long-term outcomes. These findings will help with risk stratification of lung transplant recipients and personalisation of treatment for aspiration prevention.
肺移植受者的发病率和死亡率通常由反复的误吸事件引发，而食管和胃部疾病会加剧这种情况。此前的小型研究显示，食管功能与慢性肺移植功能障碍（CLAD）的发生之间存在相互矛盾的关联。在此，我们试图在一个大型肺移植受者回顾性队列中研究食管动力障碍与长期预后之间的关系。
本研究纳入了2012年至2018年在多伦多肺移植项目接受肺移植且在移植后前7个月内有可用食管测压测试结果的所有受者。患者根据食管疾病的芝加哥分类（第3.0版）进行分类。评估食管动力障碍与CLAD发生以及移植失败（定义为死亡或再次移植）之间的关联。
在487例患者中，57例（12%）有食管胃交界流出道梗阻（OGJOO），47例（10%）有蠕动障碍（8例为主要蠕动障碍，39例为次要蠕动障碍）。在多变量分析中，OGJOO与CLAD风险增加相关（风险比[HR]1.71，95%置信区间[CI]1.15 - 2.55，p = 0.008）以及移植失败风险增加相关（HR 1.69，95% CI 1.13 - 2.53，p = 0.01）。主要蠕动障碍与CLAD风险增加相关（HR 1.55，95% CI 1.01 - 2.37，p = 0.04）以及移植失败风险增加相关（HR 3.33，95% CI 1.53 - 7.25，p = 0.002）。次要蠕动障碍与CLAD或移植失败无显著关联。
以OGJOO或主要蠕动障碍为特征的食管淤滞的肺移植受者不良长期预后风险增加。这些发现将有助于肺移植受者的风险分层以及预防误吸治疗的个体化。
