Key result
Anti-reflux surgery in lung transplant recipients improved FEV1 by 0.141 L/s and reduced the rate of FEV1 decline by 1.153 mL/day, while also improving survival (HR 0.39).
Why the study?
Gastroesophageal reflux disease and aspiration are risk factors for bronchiolitis obliterans syndrome after lung transplantation, prompting investigation into whether anti-reflux surgery improves allograft function and survival.
Does anti-reflux surgery improve lung function and survival in lung transplant recipients with gastroesophageal reflux disease?
Meta-Analysis (n=1,011)
Does anti-reflux surgery improve lung function and survival in lung transplant recipients with gastroesophageal reflux disease?
Mean Difference: 0.141 (95% CI 0.001–0.282)
Anti-reflux surgery in lung transplant recipients with gastroesophageal reflux disease significantly improves lung allograft function and medium-term survival.
Supports anti-reflux surgery for GERD in lung transplant recipients; extends meta-analytic evidence for allograft function and survival.
INTRODUCTION: Gastroesophageal reflux disease (GORD) and aspiration are risk factors in the development of bronchiolitis obliterans syndrome (BOS) in the lung transplant population. The aim of this study was to investigate if allograft function and survival improved after anti-reflux surgery (ARS) in lung transplant recipients. METHODS: In accordance with PRISMA guidelines, we conducted a systematic search of MEDLINE, Embase, and the Cochrane library databases from inception until 13/01/2024. Articles reporting outcomes of ARS following lung transplantation were included. A random effects model was used for meta-analysis. RESULTS: The search identified 20 which were used for quantitative analysis. Overall, FEV1 and rate of change of FEV1 had improved following ARS by 0.141 L/s (95% CI; -02.82, -0.001) and -1.153 mL/d (95% CI; -12.117, -0.188), respectively. Survival hazard ratio post-ARS was 0.39 (95% CI; 0.19, 0.60). Nissen fundoplication was the most effective anti-reflux procedure with the greatest effect on reduction in the rate of change of FEV1, with an improvement of -2.353 mL/d (95% CI; -3.058, -1.649). CONCLUSION: ARS in lung transplant recipients improves allograft function and survival. Given the increased incidence of GORD in lung transplant recipients, there should be a low threshold for investigation of GORD and subsequent ARS.
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Krahelski et al. (2024) conducted a meta-analysis in Gastroesophageal reflux disease in lung transplant recipients (n=1,011). Anti-reflux surgery (ARS) vs. No surgical or endoscopic procedure, medical therapy only, or pre-ARS baseline was evaluated on Improvement in FEV1 (MD 0.141 L/s, 95% CI 0.001-0.282). Anti-reflux surgery in lung transplant recipients improved FEV1 by 0.141 L/s and reduced the rate of FEV1 decline by 1.153 mL/day, while also improving survival (HR 0.39).