학술논문
Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients.
Document Type
Academic Journal
Author
Ramendra R; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Fernández-Castillo JC; 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.; Huszti E; Biostatistics Research Unit, University Health Network, Toronto, ON, Canada.; Ghany R; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Aversa M; 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.; Havlin J; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Riddell P; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Chaparro CM; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Singer LG; 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.; Liu L; Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.; Keshavjee S; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.; Yeung JC; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.; Martinu T; 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.
Source
Publisher: European Respiratory Society Country of Publication: England NLM ID: 101671641 Publication Model: eCollection Cited Medium: Print ISSN: 2312-0541 (Print) Linking ISSN: 23120541 NLM ISO Abbreviation: ERJ Open Res Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2312-0541
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Competing Interests: Conflicts of interest: P. Riddell is an associate editor of this journal. L. Liu has received honoraria from AbbVie, Medtronic, Lupin, Knight and Bausch Health as a speaker and consultant. S. Keshavjee is a corporate board member for United Therapeutics and current patent holder with SQI Diagnostics. T. Martinu received a research grant from Sanofi Inc. and research material from APCBio Innovations Inc., and collaborates (with no fees) with Trove Therapeutics. All other authors have nothing to disclose.
(Copyright ©The authors 2023.)
Methods: 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.
Results: 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.
Conclusion: 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.
Competing Interests: Conflicts of interest: P. Riddell is an associate editor of this journal. L. Liu has received honoraria from AbbVie, Medtronic, Lupin, Knight and Bausch Health as a speaker and consultant. S. Keshavjee is a corporate board member for United Therapeutics and current patent holder with SQI Diagnostics. T. Martinu received a research grant from Sanofi Inc. and research material from APCBio Innovations Inc., and collaborates (with no fees) with Trove Therapeutics. All other authors have nothing to disclose.
(Copyright ©The authors 2023.)