Early fundoplication is associated with slower decline in lung function after lung transplantation in patients with gastroesophageal reflux disease.

Autor: Biswas Roy S; Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., Elnahas S; Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., Serrone R; Department of General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., Haworth C; A.T. Still University School of Osteopathic Medicine, Mesa, Ariz., Olson MT; Grand Canyon University, Phoenix, Ariz., Kang P; University of Arizona College of Public Health, Phoenix, Ariz., Smith MA; Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., Bremner RM; Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz., Huang JL; Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. Electronic address: Jasmine.Huang@dignityhealth.org.
Jazyk: angličtina
Zdroj: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2018 Jun; Vol. 155 (6), pp. 2762-2771.e1. Date of Electronic Publication: 2018 Feb 13.
DOI: 10.1016/j.jtcvs.2018.02.009
Abstrakt: Objectives: Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation. Fundoplication slows lung function decline in patients with GERD, but the optimal timing of fundoplication is unknown.
Methods: We retrospectively reviewed patients who underwent fundoplication after lung transplantion at our center from April 2007 to July 2014. Patients were divided into 2 groups: early fundoplication (<6 months after lung transplantation) and late fundoplication (≥6 months after lung transplantation). Annual decline in percent predicted forced expiratory volume in 1 second (FEV 1 ) was analyzed.
Results: Of the 251 patients who underwent lung transplantation during the study period with available pH data, 86 (34.3%) underwent post-transplantation fundoplication for GERD. Thirty of 86 (34.9%) had early fundoplication and 56 of 86 (65.1%) had late fundoplication. Median time from lung transplantation to fundoplication was 4.6 months (interquartile range, 2.0-5.2) and 13.8 months (interquartile range, 9.0-16.1) for the early and late groups, respectively. The median DeMeester score was comparable between groups. One-, 3-, and 5-year actuarial survival rates in the early group were 90%, 70%, and 70%, respectively; in the late group, these rates were 91%, 66%, and 66% (log rank P = .60). Three- and 5-year percent predicted FEV 1 was lower in the late group by 8.9% (95% confidence interval, -30.2 to 12.38; P = .46) and 40.7% (95% confidence interval, -73.66 to -7.69; P = .019). A linear mixed model showed a 5.7% lower percent predicted FEV 1 over time in the late fundoplication group (P < .001).
Conclusions: In this study, patients with early fundoplication had a higher FEV 1 5 years after lung transplantation. Early fundoplication might protect against GERD-induced lung damage in lung transplant recipients with GERD.
(Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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