John W. Blackett, MD1, Luke Benvenuto, MD2, Selim Arcasoy, MD1, Daniela Jodorkovsky, MD1; 1Columbia University Medical Center, New York, NY; 2Columbia University Medical Center, New York City, NY
Introduction: Gastroesophageal reflux disease (GERD) can be a pre-existing condition in chronic lung disease but some patients are diagnosed with GERD following lung transplantation. GERD is known to be associated with worse transplant outcomes including development of bronchiolitis obliterans syndrome. The predictors of post-transplant de-novo GERD are unknown. This study sought to identify risk factors for the diagnosis of GERD post-lung transplant. Methods: This was a retrospective cohort study of adult patients who underwent lung transplant at Columbia University Medical Center between January 2008 and December 2018. The primary outcome was diagnosis of GERD within 3 years post-transplant, defined as a positive reflux test with elevated total percent acid exposure [ >6%], DeMeester score >14.7, or endoscopic evaluation showing erosive esophagitis. Relevant covariates including age, race, transplant type, body mass index (BMI), transplant diagnosis group, and medical comorbidities were evaluated as predictors of GERD in a multivariable logistic regression model. Results: Of 605 patients without abnormal pre-operative testing, 146 (24.1%) had positive pH reflux testing or erosive esophagitis within 3 years following transplant. Patients with post-transplant GERD had higher rates of post-transplant gastroparesis (29%) compared to those without GERD (17%, p< 0.01). On multivariable logistic regression, sex, age, history of diabetes, type of transplant, diagnosis group, renal function, body mass index, and surgeon were not significantly predictive of GERD post lung-transplant. There was a trend towards lower risk of GERD in black patients relative to white patients (OR 0.50, p=0.058), and a higher risk of GERD in cystic fibrosis patients relative to obstructive lung disease (OR 1.80, p=0.18), but this did not meet statistical significance. Discussion: GERD is common both before and after lung transplantation. However, in our study, we did not find a significant predictor of who develops GERD post-transplant. Transplant type, BMI, renal function, race, age, indication, and surgeon were not significantly associated with the development of GERD based on objective testing. As it remains unlikely to accurately predict which patients will develop GERD post-transplant, all patients should be routinely screened for symptoms and early testing pursued.
Disclosures: John Blackett indicated no relevant financial relationships. Luke Benvenuto indicated no relevant financial relationships. Selim Arcasoy indicated no relevant financial relationships. Daniela Jodorkovsky indicated no relevant financial relationships.