Role of gastroesophageal reflux disease in lung transplantation

Table 3 Papers of surgical antireflux procedures and lung transplant outcomes

Ref.	n	Population undergoing surgery	Type of surgical intervention (Type Nissen: n)	Outcomes assessed
Davis et al[32], 2003	43	Post-LTx with abnormal pH study (n = 39), severe reflux with normal manometry (n = 2), repetitive aspiration events leading to retransplant (n = 1) or pneumonia (n = 1)	Laparoscopic: 36 Open: 3 Partial Toupet: 4	In-hospital or 30-d mortality, FEV1 pre- and post-procedure
Cantu et al[40], 2004	74	Post-LTx with abnormal pH studies	Laparoscopic: 71 Open: 5 Partial Toupet: 4 Other: 51	In-hospital or 30 d mortality, freedom from BOS in early vs late fundoplication groups
Robertson et al[75], 2012	16	Post-LTx undergoing antireflux surgery	Laparoscopic: 16	Effect on quality of life, peri-operative mortality and complications, reduction in deterioration of lung function
Linden et al[117], 2006	19	Pre-LTx IPF with h/o reflux, symptoms, and severe reflux on pH and manometry testing	Laparoscopic: 19	Peri-operative complications, post-operative lung function
Lau et al[118], 2002	18	Post-LTx with documented GERD	Laparoscopic: 13 Open: 1 Partial Toupet: 4	Length of hospital stay, post-operative lung function, morbidity and mortality
Fisichella et al[119], 2011	29	Post-LTx with GERD dx on symptoms, BAL, or decreased lung function; with abnormal pH monitoring	Laparoscopic: 27	30-d morbidity and mortality, hospital readmissions
Fisichella et al[43], 2011	19	Post-LTx with GERD symptoms, aspiration on BAL, or unexplained decrease in lung function	Partial Toupet: 2 Laparoscopic: 19	decreased aspiration as defined by the presence of pepsin in the BALF
Fisichella et al[74], 2012	8	Post-LTx patients with GERD and evidence of reflux on ambulatory pH monitoring	Laparoscopic: 8	Quantification and comparison of pulm leukocyte differential and concentration of inflammatory mediators in BAL, freedom from BOS, effect on FEV1, and survival
Burton et al[120], 2009	21	Post-LTx with reflux confirmed on EGD, pH testing, or BALF	Laparoscopic: 5 Partial Toupet: 16	Patient satisfaction, symptom changes and side effects, effect on lung function, BMI, rate progression to BOS
O’Halloran et al[121], 2004	28	Post-LTx with reflux on pH testing and manometry	Laparoscopic: 28	Perioperative complications, length of stay, readmission rate, effect on lung function
Gasper et al[122], 2008	35	Pre-LTx in 15 patients, Post-LTx in 20 patients with GERD or delayed gastric emptying study	Laparoscopic: 27 Partial Toupet: 5 Other: 32	Length of stay, perioperative complications pre- or post-LTx
Kilic et al[17], 2013	401	Post-LTx who pursued elective antireflux procedure	Laparoscopic: 3383 Open: 23	Inpatient mortality, length of stay, perioperative complications, hospital costs
Hoppo et al[16], 2011	43	Pre-LTx in 19 patients, Post-LTx in 24 patients with documented symptoms or signs of GERD on EGD, barium, manometry, pH or impedance testing; or declining lung function	Laparoscopic: 24 Other: 174	Effect on lung function, number cases of pneumonia and acute rejection episodes
Hartwig et al[126], 2011	157	Post-LTx with abnormal acid contact times before or early after transplantation	Laparoscopic: 1573	Effect on lung function
Lo et al[103], 2016	48	Pre-LTx or Post-LTx patients with persistent symptoms on maximal PPI and with objective evidence of reflux on pH testing	Laparoscopic = 48	Time to early allograft injury in pre-LTx vs early vs late post-LTx groups
Patti et al[114], 2000	39	Pt with GERD and respiratory symptoms on H2 agents vs PPI vs pro-kinetic agents, ± bronchodilators (n = 3) and bronchodilators/prednisone (n = 4)	Laparoscopic = 39	Outcome of surgery on GERD-induced respiratory symptoms

¹Three cases Belsey-Mark IVs, 1 Toupet and 1 Nissen at OSH (without further information);

²Two cases had pyloroplasty without fundoplication, 1 case had hypotension at induction and was discharged without operation;

³Does not specify full Nissen vs partial toupet, only laparoscopic vs open approach;

⁴Seventeen cases underwent laparoscopic Dor procedure. n: Study patients in the fundoplication group specifically; LTx: Lung transplant; BALF: Bronchoalveolar lavage fluid; BOS: Bronchiolitis obliterans syndrome; GERD: Gastroesophageal reflux disease; BMI: Body mass index; EGD: esophagogastroduodenoscopy.