Takahiro Masuda, MD, Sumeet K Mittal, MD, Balazs Kovacs, MD, Michael A Smith, MD, Rajat Walia, MD, Jasmine Huang, MD, Ross M Bremner. Norton Thoracic Institute; St. Joseph’s Hospital and Medical Cener
INTRODUCTION: Impaired esophageal motility results in poor esophageal clearance, and can exacerbate gastroesophageal reflux which is a potential risk for allograft dysfunction in lung transplant (LTx) recipients. However, the clinical course after LTx in patients with absent esophageal body motility has not been well described. The aim of this study is to explore the outcomes of LTx in patients with absent contractility.
METHODS: We retrospectively reviewed the records of all patients who underwent lung transplantation at our institution between 2015 and 2016. Patients who underwent high-resolution esophageal manometry both before and after LTx were identified. We compared patients who diagnosed with absent esophageal body motility before LTx and patients who diagnosed with normal esophageal motility both pre- and post-LTx. Manometric diagnoses were performed based on Chicago classification v3.0.
RESULTS: Of the 204 patients who underwent LTx during the study period, pre-LTx absent esophageal body contractility was seen in 10 patients including 2 patients diagnosed with achalasia type I, and 36 patients were diagnosed with normal motility both pre- and post-LTx. In patients with absent motility, there were 2 patients with chronic obstructive pulmonary disease, 7 patients with idiopathic pulmonary fibrosis, and 1 patient with scleroderma. Lung allocation score was higher in patients with absent esophageal body contractility than those with normal motility (40.3 vs 35.1, p=0.033). The 1-, 2-, and 3-year post-LTx survival for patients with absent motility were 80, 80, and 37.5%, respectively, and was lower than normal motility cohort (100, 93.5, 84.6%, respectively; log-rank test, p=0.002). Based on 24-hour pH monitoring, significantly greater %time pH<4 and DeMeester score were noted in patients with absent motility than those with normal motility before LTx (8.9% vs 2.5%, p=0.014; 30.3 vs 10.5, p=0.016), and the same trend was seen after LTx although it did not reach statistical significance (8.2% vs 2.9%, p=0.176; 27.6 vs 17.8, p=0.176). Importantly, esophageal body motility was improved after LTx in six out of 10 patients with absent motility. Two of 6 patients with improved esophageal motility showed normal esophageal body motility.
CONCLUSIONS: We have demonstrated that esophageal motility does improve in some patients after LTx even in patients with absent esophageal motility. The 2-year outcome of LTx in patients with absent motility seems to be reasonable, although the 3-year outcome requires improvement. Fundoplication for patients with improved esophageal motility may help better outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93706
Program Number: P526
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster