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J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.

Publication ,  Journal Article
Cantu, E; Appel, JZ; Hartwig, MG; Woreta, H; Green, C; Messier, R; Palmer, SM; Davis, RD
Published in: Ann Thorac Surg
October 2004

BACKGROUND: Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival. METHODS: A retrospective analysis of 457 patients who underwent lung transplantation from April 1992 through July 2003 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (< 90 days) fundoplication and history of reflux and late fundoplication. RESULTS: Incidence of postoperative reflux was 76% (127 of 167 patients) in pH confirmed subgroups. In 14 patients with early fundoplication, actuarial survival was 100% at 1 and 3 years when compared with those with reflux and no intervention (92% +/- 3.3, 76% +/- 5.8; p < 0.02). Further, those who underwent early fundoplication had improved freedom from bronchiolitis obliterans syndrome at 1 and 3 years (100%, 100%) when compared with no fundoplication in patients with reflux (96% +/- 2.5, 60% +/- 7.5; p < 0.01). CONCLUSIONS: Reflux is a frequent medical complication after lung transplantation. Although the number of patients undergoing early fundoplication is small, our results suggest early aggressive surgical treatment of reflux results in improved rates of bronchiolitis obliterans syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2004

Volume

78

Issue

4

Start / End Page

1142 / 1151

Location

Netherlands

Related Subject Headings

  • Transplantation, Homologous
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lung Transplantation
  • Life Tables
  • Incidence
 

Citation

APA
Chicago
ICMJE
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Cantu, E., Appel, J. Z., Hartwig, M. G., Woreta, H., Green, C., Messier, R., … Davis, R. D. (2004). J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg, 78(4), 1142–1151. https://doi.org/10.1016/j.athoracsur.2004.04.044
Cantu, Edward, James Z. Appel, Matthew G. Hartwig, Hiwot Woreta, Cindy Green, Robert Messier, Scott M. Palmer, and R Duane Davis. “J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.Ann Thorac Surg 78, no. 4 (October 2004): 1142–51. https://doi.org/10.1016/j.athoracsur.2004.04.044.
Cantu E, Appel JZ, Hartwig MG, Woreta H, Green C, Messier R, et al. J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg. 2004 Oct;78(4):1142–51.
Cantu, Edward, et al. “J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.Ann Thorac Surg, vol. 78, no. 4, Oct. 2004, pp. 1142–51. Pubmed, doi:10.1016/j.athoracsur.2004.04.044.
Cantu E, Appel JZ, Hartwig MG, Woreta H, Green C, Messier R, Palmer SM, Davis RD. J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg. 2004 Oct;78(4):1142–1151.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2004

Volume

78

Issue

4

Start / End Page

1142 / 1151

Location

Netherlands

Related Subject Headings

  • Transplantation, Homologous
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lung Transplantation
  • Life Tables
  • Incidence