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180: Early Fundoplication Reduces the Incidence of Chronic Allograft Dysfunction in Patients with Gastroesophageal Reflux Disease
The Journal of Heart and Lung Transplantation Volume 27, Number 2S
Results: Time of BAL sampling was comparable in C and NC patients: 376 (93-442) vs. 363 (156-369) days (p⫽NS). BAL BA levels, but not pepsin levels, as well as IL-8 and neutrophils were elevated in C patients (figure 1). Generally, BA levels, but not pepsin levels, positively correlated with BAL IL8 and neutrophilia (figure 2). Conclusions: Bile acid aspiration seems to be associated with P.aeruginosa airway colonization after LTx. Their possible role for inducing neutrophilic airway inflammation in the development of BOS after LTx should be further elucidated. Research funded by Research Foundation-Flanders (FWO) and GSK Belgium.
Abstracts
S125
variety of non-immune mediated factors contribute to development of bronchiolitis obliterans syndrome (BOS). Foremost amongst these is gastroesophageal reflux disease (GERD). We have previously demonstrated that in select patients, anti-reflux surgery can reverse BOS. More recently, we described that early fundoplication prevents the development of BOS at short-term follow-up. We now hope to explore what role GERD and fundoplication have on survival and BOS with long-term follow-up. Methods and Materials: A retrospective analysis of 610 patients who underwent lung transplantation between April 1992 and December 2005 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (⬍90 days) fundoplication and history of reflux and late fundoplication. All patients had at least one-year follow-up. Results: The incidence of post-operative reflux was 81% in pH study confirmed subgroups. Survival at one year was equivalent between reflux and non-reflux groups (94.6% v 92.2%, p⫽0.28). Similarly, survival between early and late fundoplication groups showed no significant difference (97.0% v 97.2%, p⫽0.93). However, subgroup analysis demonstrated a 15.9% incidence of BOS in the early fundoplication group (N⫽67) compared to 47.7% in the late group (N⫽117) (p⬍0.0001). Conclusions: Patients undergoing lung transplantation are subject to multiple potential complications. Foremost amongst these is GERD with the potential for long-term graft failure. These data lend credence to the emerging view that GERD is a principle player in the development of chronic lung allograft rejection. More importantly, our results suggest that aggressive early fundoplication results in decreased incidence of BOS. Further investigation is necessary to determine the long-term effect of GERD on survival as well as the mechanism by which GERD may facilitate chronic allograft rejection.
181 Pepsin or Bile Acids: What Is the Best Marker of Gastric Aspiration in Lung Transplant Recipients? V. Mertens,1 K. Blondeau,1 B.M. Vanaudenaerde,2 R. Vos,2 D.E. Van Raemdonck,2,3 G.M. Verleden,2,3 D. Sifrim,1 L.J. Dupont,2,3 1Center for Gastroenterological Research, University Hospital Gasthuisberg, Leuven, Belgium; 2Laboratory of Pneumology, Catholic University Leuven, Leuven, Belgium; 3 Lung Transplantation Unit, University Hospital Gasthuisberg, Leuven, Belgium
180 Early Fundoplication Reduces the Incidence of Chronic Allograft Dysfunction in Patients with Gastroesophageal Reflux Disease K.R. Balsara,1 E. Cantu,1 E.L. Bush,1 J.Z. Appel,1 M.G. Hartwig,1 S.S. Lin,1 R.D. Davis,1 1Surgery, Duke University Medical Center, Durham, NC Purpose: Chronic allograft dysfunction limits the long-term success of lung transplantation. Recent evidence suggests that a
Purpose: Increased gastroesophageal reflux (GER) and aspiration of gastric contents may favour the development of BOS. Markers of aspiration (pepsin and bile acids) in the BAL of LTx patients may feature as selection criteria for antireflux surgery. The aim was to compare the repeatability and the predictive value for BOS development of pepsin and bile acids in BAL, obtained early after LTx. Methods and Materials: Repeatability of pepsin and bile acids levels was tested in 18 stable LTx patients (15 SS, 3 SLTx) comparing BAL obtained at 3 and 12 mo after LTx. A retrospective case-control study was performed in 37 LTx patients (25 SS, 10 S, 2 HLTx) to assess the predictive value of BAL 3 mo after LTx. Stable patients had no BOS and a follow up ⬎ 36 mo after LTx, BOS patients had BOS grade ⱖ 1. Compared to 14 non transplant controls, pepsin and bile acids were considered positive if ⬎ 25.4 ng/ml and if ⬎ 0.22 M, respectively. Results: 16/18 stable patients were positive for pepsin in BALF at 3 mo and remained positive at 12 mo. 14/18 stable LTx had no bile acids in the BALF at 3 mo and 12 of these patients remained negative for bile acids 12 mo after LTx.
Results: Time of BAL sampling was comparable in C and NC patients: 376 (93-442) vs. 363 (156-369) days (p⫽NS). BAL BA levels, but not pepsin levels, as well as IL-8 and neutrophils were elevated in C patients (figure 1). Generally, BA levels, but not pepsin levels, positively correlated with BAL IL8 and neutrophilia (figure 2). Conclusions: Bile acid aspiration seems to be associated with P.aeruginosa airway colonization after LTx. Their possible role for inducing neutrophilic airway inflammation in the development of BOS after LTx should be further elucidated. Research funded by Research Foundation-Flanders (FWO) and GSK Belgium.
Abstracts
S125
variety of non-immune mediated factors contribute to development of bronchiolitis obliterans syndrome (BOS). Foremost amongst these is gastroesophageal reflux disease (GERD). We have previously demonstrated that in select patients, anti-reflux surgery can reverse BOS. More recently, we described that early fundoplication prevents the development of BOS at short-term follow-up. We now hope to explore what role GERD and fundoplication have on survival and BOS with long-term follow-up. Methods and Materials: A retrospective analysis of 610 patients who underwent lung transplantation between April 1992 and December 2005 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (⬍90 days) fundoplication and history of reflux and late fundoplication. All patients had at least one-year follow-up. Results: The incidence of post-operative reflux was 81% in pH study confirmed subgroups. Survival at one year was equivalent between reflux and non-reflux groups (94.6% v 92.2%, p⫽0.28). Similarly, survival between early and late fundoplication groups showed no significant difference (97.0% v 97.2%, p⫽0.93). However, subgroup analysis demonstrated a 15.9% incidence of BOS in the early fundoplication group (N⫽67) compared to 47.7% in the late group (N⫽117) (p⬍0.0001). Conclusions: Patients undergoing lung transplantation are subject to multiple potential complications. Foremost amongst these is GERD with the potential for long-term graft failure. These data lend credence to the emerging view that GERD is a principle player in the development of chronic lung allograft rejection. More importantly, our results suggest that aggressive early fundoplication results in decreased incidence of BOS. Further investigation is necessary to determine the long-term effect of GERD on survival as well as the mechanism by which GERD may facilitate chronic allograft rejection.
181 Pepsin or Bile Acids: What Is the Best Marker of Gastric Aspiration in Lung Transplant Recipients? V. Mertens,1 K. Blondeau,1 B.M. Vanaudenaerde,2 R. Vos,2 D.E. Van Raemdonck,2,3 G.M. Verleden,2,3 D. Sifrim,1 L.J. Dupont,2,3 1Center for Gastroenterological Research, University Hospital Gasthuisberg, Leuven, Belgium; 2Laboratory of Pneumology, Catholic University Leuven, Leuven, Belgium; 3 Lung Transplantation Unit, University Hospital Gasthuisberg, Leuven, Belgium
180 Early Fundoplication Reduces the Incidence of Chronic Allograft Dysfunction in Patients with Gastroesophageal Reflux Disease K.R. Balsara,1 E. Cantu,1 E.L. Bush,1 J.Z. Appel,1 M.G. Hartwig,1 S.S. Lin,1 R.D. Davis,1 1Surgery, Duke University Medical Center, Durham, NC Purpose: Chronic allograft dysfunction limits the long-term success of lung transplantation. Recent evidence suggests that a
Purpose: Increased gastroesophageal reflux (GER) and aspiration of gastric contents may favour the development of BOS. Markers of aspiration (pepsin and bile acids) in the BAL of LTx patients may feature as selection criteria for antireflux surgery. The aim was to compare the repeatability and the predictive value for BOS development of pepsin and bile acids in BAL, obtained early after LTx. Methods and Materials: Repeatability of pepsin and bile acids levels was tested in 18 stable LTx patients (15 SS, 3 SLTx) comparing BAL obtained at 3 and 12 mo after LTx. A retrospective case-control study was performed in 37 LTx patients (25 SS, 10 S, 2 HLTx) to assess the predictive value of BAL 3 mo after LTx. Stable patients had no BOS and a follow up ⬎ 36 mo after LTx, BOS patients had BOS grade ⱖ 1. Compared to 14 non transplant controls, pepsin and bile acids were considered positive if ⬎ 25.4 ng/ml and if ⬎ 0.22 M, respectively. Results: 16/18 stable patients were positive for pepsin in BALF at 3 mo and remained positive at 12 mo. 14/18 stable LTx had no bile acids in the BALF at 3 mo and 12 of these patients remained negative for bile acids 12 mo after LTx.