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Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study.

Publication ,  Journal Article
Green, CL; Gulack, BC; Keshavjee, S; Singer, LG; McCurry, K; Budev, MM; Reece, TL; Lidor, AO; Palmer, SM; Davis, RD
Published in: Ann Thorac Surg
April 2023

BACKGROUND: Aspiration has been associated with graft dysfunction after lung transplantation, leading some to advocate for selective use of fundoplication despite minimal data supporting this practice. METHODS: We performed a multicenter retrospective study at 4 academic lung transplant centers to determine the association of gastroesophageal reflux disease and fundoplication with bronchiolitis obliterans syndrome and survival using Cox multivariable regression. RESULTS: Of 542 patients, 136 (25.1%) underwent fundoplication; 99 (18%) were found to have reflux disease without undergoing fundoplication. Blanking the first year after transplantation, fundoplication was not associated with a benefit regarding freedom from bronchiolitis obliterans syndrome (hazard ratio [HR], 0.93; 95% CI, 0.58-1.49) or death (HR, 0.97; 95% CI, 0.47-1.99) compared with reflux disease without fundoplication. However, a time-dependent adjusted analysis found a slight decrease in mortality (HR, 0.59; 95% CI, 0.28-1.23; P = .157), bronchiolitis obliterans syndrome (HR, 0.68; 95% CI, 0.42-1.11; P = .126), and combined bronchiolitis obliterans syndrome or death (HR, 0.66; 95% CI, 0.42-1.04; P = .073) in the fundoplication group compared with the gastroesophageal reflux disease group. CONCLUSIONS: Although a statistically significant benefit from fundoplication was not determined because of limited sample size, follow-up, and potential for selection bias, a randomized, prospective study is still warranted.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2023

Volume

115

Issue

4

Start / End Page

1024 / 1032

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Respiratory System
  • Prospective Studies
  • Lung Transplantation
  • Humans
  • Gastroesophageal Reflux
  • Bronchiolitis Obliterans Syndrome
  • Bronchiolitis Obliterans
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Green, C. L., Gulack, B. C., Keshavjee, S., Singer, L. G., McCurry, K., Budev, M. M., … Davis, R. D. (2023). Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg, 115(4), 1024–1032. https://doi.org/10.1016/j.athoracsur.2022.09.037
Green, Cynthia L., Brian C. Gulack, Shaf Keshavjee, Lianne G. Singer, Kenneth McCurry, Marie M. Budev, Tammy L. Reece, Anne O. Lidor, Scott M. Palmer, and R Duane Davis. “Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study.Ann Thorac Surg 115, no. 4 (April 2023): 1024–32. https://doi.org/10.1016/j.athoracsur.2022.09.037.
Green CL, Gulack BC, Keshavjee S, Singer LG, McCurry K, Budev MM, et al. Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg. 2023 Apr;115(4):1024–32.
Green, Cynthia L., et al. “Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study.Ann Thorac Surg, vol. 115, no. 4, Apr. 2023, pp. 1024–32. Pubmed, doi:10.1016/j.athoracsur.2022.09.037.
Green CL, Gulack BC, Keshavjee S, Singer LG, McCurry K, Budev MM, Reece TL, Lidor AO, Palmer SM, Davis RD. Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg. 2023 Apr;115(4):1024–1032.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2023

Volume

115

Issue

4

Start / End Page

1024 / 1032

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Respiratory System
  • Prospective Studies
  • Lung Transplantation
  • Humans
  • Gastroesophageal Reflux
  • Bronchiolitis Obliterans Syndrome
  • Bronchiolitis Obliterans
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology