Delayed gastric emptying prior to lung transplantation a warning signal for rejection

For lung transplant recipients, delayed gastric emptying (DGE) prior to transplantation appears to convey a heightened risk of acute cellular rejection, regardless of the presence of gastroesophageal reflux disease (GERD), a study has found.

The retrospective analysis included 83 consecutive patients (mean age, 53.6 years; 51.8 percent male) undergoing prelung transplant evaluation. Eighteen of them had DGE.

According to gastric emptying scintigraphy data, patients with versus without DGE were more likely to have typical symptoms of gastroparesis, although 61.1 percent of DGE patients were asymptomatic.

Acute cellular rejection, diagnosed using the International Society for Heart and Lung Transplantation (ISHLT) histologic criteria, was highly prevalent among patients with DGE (33.3 percent vs 12.3 percent; p=0.04). This association was not modified by GERD as evaluated by 24-hour pH impedance monitoring on subgroup analysis (75 percent vs 14.3 percent; p=0.02).

DGE has been shown to frequently occur (23–91 percent) after lung transplantation, and it predisposes patients to microaspiration, leading to poor post-transplant outcomes. The findings underscore the potential utility of routine pretransplant testing for DGE to pinpoint patients at greater risk of adverse post-transplant outcomes.

A serious complication in lung transplantation, acute cellular rejection may lead to acute graft dysfunction or failure and is a major established risk factor for the development of chronic lung allograft dysfunction, particularly the bronchiolitis obliterans syndrome. Thus, early detection and treatment of acute rejection is of critical importance for lung transplant recipients. [J Thorac Dis 2017;9:5440-5457]