Anti-reflux surgery for lung transplant recipients in the presence of impedance-detected duodenogastroesophageal reflux and bronchiolitis obliterans syndrome: A study of efficacy and safety

BACKGROUND: The aim of this study was to determine the safety of anti-reflux surgery for lung transplant recipients and assess its effect on lung function. METHODS: We retrospectively collected and analyzed data from all lung transplant recipients who underwent anti-reflux surgery at St Mary's Hospital London from July 2005 to May 2012. The indications for surgery were histologic evidence of gastroesophageal reflux aspiration on bronchoscopy biopsy specimens or a positive impedance study with symptomatic reflux or a consistent decline/fluctuating forced expiratory volume in 1 second (FEV1). We studied the difference in mean FEV1 and rate of change of FEV1, before and after fundoplication. The safety of anti-reflux surgery was determined by post-operative morbidity and mortality and compared with predicted figures, using a risk prediction model based on the P-POSSUM (Portsmouth Modification of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) assessment. RESULTS: Forty patients underwent laparoscopic Nissen fundoplication. Overall, mean FEV1 declined from 2119 +/- 890 to 1967 +/- 1027 ml (p = 0.027), and mean rate of change in FEV1 improved from 2.42 +/- 4.40 to -0.41 +/- 1.77 ml/day (p = 0.007). Patients referred for fundoplication based on histologic evidence of reflux (n = 9) showed an improvement in rate of change of FEV1 from 3.39 +/- 6.00 to 0.17 +/- 1.50 ml/day (p = 0.057), and those with positive iinpedance study and consistent decline in FEV1 (n = 13) showed a significant improvement from -3.62 +/- 3.35 to -0.74 +/- 2.33 ml (p = 0.021). Actual and predicted morbidity was 2.5% and 31%, respectively. Actual and predicted 30-day mortality was 0% and 1.9%, respectively. CONCLUSIONS: Anti-reflux surgery is safe for lung transplant recipients and results in an improvement in the rate of change in FEV1 despite a decline in mean FEV1 post-operatively. (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.