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THE EFFECTS OF ESOPHAGEAL APERISTALSIS ON LUNG ALLOGRAFT FUNCTION: A SINGLE CENTER STUDY
Monica Stevens, William N. Doyle, Michael Rogers, Pavani Peddi
*, Rahul Mhaskar, Ishna Poojna-Hohman, Joseph Sujka, Samer Ganam, Vic Velanovich, Kapil Patel, Christopher DuCoin
Gastrointestinal Surgery, University of South Florida, Tampa, FL
Background Esophageal dysmotility increases the risk of acute lung allograft dysfunction (ALA) and chronic allograft lung dysfunction (CLAD), which results in decreased post-transplant survival rates in lung transplants recipients. Due to short and long-term complication risks, complete esophageal aperistalsis has historically been considered a contraindication for lung transplantation. However, literature suggests that esophageal motility can improve post-transplant.
Methods All patients with known aperistalsis of the esophagus prior to lung transplantation were identified at our center. Retrospective chart review was conducted to observe the post-lung transplant pulmonary and esophageal function that these patients experienced.
Results We identified six patients with complete esophageal aperistalsis for our observational study. Two patients (33.3%) had the diagnosis of scleroderma while a single patient had each of the following diagnoses: Mixed connective tissue disease (16.7%), polymyositis (16.7%), sarcoidosis (16.7%), and idiopathic pulmonary fibrosis (16.7). One patient experienced acute allograft rejection secondary to aspiration, which was resolved with medical treatment. Many patients experienced aspiration events however their respective lung biopsies did not show evidence of allograft dysfunction. Patients remained NPO (nothing by mouth) from a range of 3 months post lung transplantation to the remainder of their life. Esophageal motility was observed to be improved in 33% of patients with two patients expiring prior to a post-transplant manometry. Poor weight gain was observed as well as frequent gastrojejunostomy (GJ) tube clogging and replacement.
Conclusions Select patients may experience improvement in previously known esophageal dysfunction post lung transplantation. Careful selection of patients remains paramount to minimize risk of aspiration, ALAD and CLAD.
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