Abstract | BACKGROUND: METHODS: Only primary lung transplant recipients were included. Reflux status was assessed with pH monitoring, impedance plethysmography, and esophagogastroduodenoscopy. Sensitivity to col(V) was determined with trans vivo delayed-type hypersensitivity reaction (DTH). Kaplan-Meier analyses were performed. RESULTS: Of the 54 recipients, 26 had proven GERD. There were no significant between-group differences in diagnosis; donor and recipient age; sex; ischemic time; single vs bilateral; human leukocyte antigen A, B, and DR matching cytomegalovirus status; acute rejections; or mean follow-up period. The mean DTH response in the GERD group was 25.7 x 10(-4) inches vs 18.3 x 10(-4) inches in the non- GERD group (P = .023). There was a significant reduction in BOS-free survival in the GERD group for both BOS-I ( GERD+, 28.3%; GERD-, 86.6%; P = .0001) and BOS-II/III ( GERD+, 66.2%; GERD-, 91.7%; P = .0374). A second cohort of 53 patients awaiting lung transplantation also was assayed. The mean DTH response in the GERD group was 24.0 x 10(-4) inches vs 13.1 x 10(-4) inches in the non- GERD group (P = .003). There were no differences in age or sex. CONCLUSIONS:
GERD is strongly associated with the development of BOS after primary lung transplantation. Col(V) sensitization is associated with reflux and BOS and may play an intermediary role in the pathogenesis of BOS. Trials using col(V) reactivity to assess the impact of antireflux procedures in patients with lung transplantation and idiopathic pulmonary fibrosis are warranted.
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Authors | Joseph L Bobadilla, Ewa Jankowska-Gan, Qingyong Xu, Lynn D Haynes, Alejandro Munoz del Rio, Keith Meyer, Daniel S Greenspan, Nilto De Oliveira, William J Burlingham, James D Maloney |
Journal | Chest
(Chest)
Vol. 138
Issue 2
Pg. 363-70
(Aug 2010)
ISSN: 1931-3543 [Electronic] United States |
PMID | 20418369
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Bronchiolitis Obliterans
(etiology, physiopathology)
- Collagen Type V
(physiology)
- Female
- Gastroesophageal Reflux
(complications)
- Humans
- Lung Diseases
(surgery)
- Lung Transplantation
(adverse effects)
- Male
- Middle Aged
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