Increase in failed swallows from pre- to post-lung transplant esophageal function testing is associated with acute rejection

doi:10.5500/wjt.v15.i4.107149

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Transplant. Dec 18, 2025; 15(4): 107149
Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.107149

Table 1 Baseline demographics and clinical characteristics of study cohort, n (%)

	Total (N = 55)	Decreased failed swallows post-transplant (n = 16)	Unchanged failed swallows post-transplant (n = 17)	Increased failed swallows post-transplant (n = 22)	P value (χ² or ANOVA)
Follow up, mean (years)	2.77 (SD 1.96)	2.98 (SD 1.56)	2.42 (SD 1.81)	2.89 (SD 2.35)	0.71
Male sex	36 (65.4)	12 (75.0)	13 (76.5)	11 (50.0)	0.14
BMI, mean	26.9 (SD 4.34)	25.7 (SD 3.15)	28.5 (SD 3.74)	26.4 (SD 5.21)	0.23
Age at transplant, mean	61.0 (SD 7.58)	61.3 (SD 7.92)	62.0 (SD 7.70)	60.1 (SD 7.47)	0.97
White race	49 (89.1)	16 (100)	16 (94.1)	17 (77.3)	0.06
Pulmonary diagnosis
ILD	42 (76.4)	13 (81.2)	12 (70.6)	17 (77.3)	0.76
IPF	28 (50.9)	9 (56.2)	8 (47.1)	11 (50.0)	0.86
COPD	11 (20.0)	3 (18.7)	4 (23.5)	4 (18.2)	0.91
Cardiac function, baseline
LVEF, mean	59.9 (SD 5.26)	58.8 (SD 4.74)	59.7 (SD 4.71)	60.9 (SD 6.03)	0.13
PaP, mean (mmHg)	26.6 (SD 10.1)	25.6 (SD 10.7)	28.4 (SD 12.7)	26.0 (SD 7.40)	0.47
PCWP, mean (mmHg)	10.1 (SD 4.71)	10.6 (SD 4.99)	10.3 (SD 4.98)	9.64 (SD 4.46)	0.59
PVR, mean (dynes∙sec∙cm^-5)	244 (SD 189)	236 (SD 196)	283 (SD 257)	220 (SD 109)	0.76
Pulmonary function, baseline
FVC	2.25 (SD 0.91)	2.48 (SD 0.78)	2.29 (SD 1.10)	2.06 (SD 0.83)	0.44
FVC, %-pred	0.54 (SD 0.18)	0.60 (SD 0.18)	0.54 (SD 0.21)	0.50 (SD 0.14)	0.65
FEV1	1.68 (SD 0.81)	1.94 (SD 0.79)	1.67 (SD 0.96)	1.50 (SD 0.68)	0.38
FEV1, %-pred	0.52 (SD 0.22)	0.60 (SD 0.24)	0.50 (SD 0.27)	0.48 (SD 0.16)	0.85
FEV1/FVC	0.74 (SD 0.19)	0.76 (SD 0.16)	0.71 (SD 0.20)	0.74 (SD 0.20)	0.96
TLC, %-pred	0.62 (SD 0.29)	0.67 (SD 0.22)	0.58 (SD 0.21)	0.63 (SD 0.38)	0.26
Bilateral lung transplant	50 (90.9)	14 (87.5)	15 (88.2)	21 (95.4)	0.63
CMV mismatch	22 (40.0)	7 (43.7)	8 (47.1)	7 (31.8)	0.59
Increased risk donor	26 (47.3)	10 (62.5)	6 (35.3)	10 (45.4)	0.29
Pre-transplant AET, mean¹ (%)	2.45 (SD 2.29)	2.64 (SD 2.80)	2.58 (SD 1.62)	2.27 (SD 2.36)	0.44
Post-transplant AET, mean² (%)	2.41 (SD 5.28)	3.51 (SD 8.27)	3.26 (SD 4.54)	0.89 (SD 1.52)	0.33
Post-transplant infection	50 (90.9)	15 (93.7)	17 (100)	18 (81.8)	0.13
Post-transplant PPI	42 (76.4)	14 (87.5)	12 (70.6)	16 (72.7)	0.45
Pre-transplant failed swallows, mean	0.13 (SD 0.19)	0.27 (SD 0.20)	0	0.13 (SD 0.18)	< 0.0001
Post-transplant failed swallows, mean	0.17 (SD 0.23)	0.10 (SD 0.10)	0	0.34 (SD 0.27)	< 0.0001
Change in failed swallows, mean	+0.03 (SD 0.23)	-0.18 (SD 0.18)	0	+0.21 (SD 0.21)	< 0.0001

¹Available in 37/55 subjects.

²Available in 54/55 subjects.

BMI: Body mass index; IPF: Idiopathic pulmonary fibrosis; ILD: Interstitial lung fibrosis; COPD: Chronic obstructive pulmonary disease; CF: Cystic fibrosis; LVEF: Left ventricular ejection fraction; PaP: pulmonary artery pressure; PCWP: Pulmonary capillary wedge pressure; PVR: Pulmonary vascular resistance; FVC: Forced vital capacity; %-pred: Percent predicted value; FEV1: Forced expiratory volume in 1 second; CMV: Cytomegalovirus; AET: Acid Exposure Time; PPI: Proton pump inhibitor. Increased risk donors were those with hepatitis C infection. Post-transplant infection were those with infection detected on bronchoalveolar lavage prior to pulmonary decline.

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Citation: Lo WK, Nadella P, Feldman N, Sharma N, Goldberg HJ, Chan WW. Increase in failed swallows from pre- to post-lung transplant esophageal function testing is associated with acute rejection. World J Transplant 2025; 15(4): 107149
URL: https://www.wjgnet.com/2220-3230/full/v15/i4/107149.htm
DOI: https://dx.doi.org/10.5500/wjt.v15.i4.107149

Lo WK, Nadella P, Feldman N, Sharma N, Goldberg HJ, Chan WW. Increase in failed swallows from pre- to post-lung transplant esophageal function testing is associated with acute rejection. World J Transplant 2025; 15(4): 107149 [PMID: 41357378 DOI: 10.5500/wjt.v15.i4.107149]

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