Esophageal aperistalsis and lung transplant: Recovery of peristalsis after transplant is associated with improved long-term outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 160; no. 6; pp. 1613 - 1626
• Main Authors: Masuda, Takahiro, Mittal, Sumeet K., Csucska, Máté, Kovacs, Balazs, Walia, Rajat, Huang, Jasmine L., Smith, Michael A., Bremner, Ross M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Aged; Deglutition Disorders - physiopathology; esophageal motility disorders; Esophageal pH Monitoring; esophagus; Esophagus - metabolism; Esophagus - physiopathology; Female; Follow-Up Studies; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - physiopathology; Humans; lung transplantation; Lung Transplantation - methods; Male; Manometry; Middle Aged; peristalsis; Peristalsis - physiology; Prognosis; Prospective Studies; Recovery of Function; Respiratory Insufficiency - complications; Respiratory Insufficiency - surgery; Time Factors; peristalsis; HRM; AMR; BOS; EGJ; DCI; ISHLT; ACR; GERD; LTx; CLAD; esophageal motility disorders; lung transplantation; LES; esophagus
• DOI: 10.1016/j.jtcvs.2019.12.120
• ISSN: 0022-5223

Esophageal aperistalsis has been considered a relative contraindication for lung transplant because of a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. We previously reported that esophageal motility improves in some patients after lung transplant. We reviewed the clinical course of lung transplant recipients diagnosed with an aperistaltic esophagus on pretransplant testing. We identified patients diagnosed with pretransplant aperistaltic esophagus on high-resolution manometry who underwent lung transplant. Recipients with normal esophageal motility before lung transplant were used as the propensity score–matched control group. High-resolution manometry was repeated after lung transplant, and patients with aperistalsis were further divided into 2 subgroups: improved esophageal peristalsis and nonimproved peristalsis (ie, persistent aperistalsis after lung transplant). Esophageal aperistalsis was seen in 31 patients (mean age, 59.0 years; 21 men). The 1-, 3-, and 5-year post–lung transplant survivals in the aperistalsis group were 80.6%, 51.2%, and 34.9%, respectively, which was significantly lower than in the control group (90.3%, 73.4%, and 58.8%, respectively; P = .038). Post–lung transplant high-resolution manometry was performed for 29 patients in the aperistalsis group, 19 of whom demonstrated improved esophageal motility (65.5%). The 1-, 3-, and 5-year survivals after lung transplant of patients with recovery of peristalsis were similar to those of the control group (89.5%, 65.0%, and 48.8%, respectively; P = 1.000), whereas the nonimproved peristalsis group had lower survival (80.0%, 36.0%, and data unavailable, respectively; P = .012). Esophageal aperistalsis is not necessarily a contraindication for lung transplant. Improved peristalsis can be expected in up to two-thirds of these patients and is associated with good outcomes. [Display omitted]