Sa164 SLEEP POSITIONING DEVICE SIGNIFICANTLY IMPROVES GASTROESOPHAGEAL REFLUX DISEASE IN LUNG TRANSPLANT RECIPIENTS: A COHORT STUDY.

AbstractRationaleGastroesophageal reflux disease (GERD) may affect lung allograft inflammation and function through its effects on allograft microbial community composition in lung transplant recipients.ObjectivesOur objective was to compare the allograft microbiota in lung transplant recipients with or without clinically diagnosed GERD in the first post-transplant year, and assess associations between GERD, allograft microbiota, inflammation and acute and chronic lung allograft dysfunction (ALAD/CLAD).Methods268 bronchoalveolar lavage samples were collected from 75 lung transplant recipients at a single transplant centre every 3 months post-transplant for 1 year. Ten transplant recipients from a separate transplant centre provided samples pre/post-anti-reflux Nissen fundoplication surgery. Microbial community composition and density were measured using 16S rRNA gene sequencing and qPCR, respectively and inflammatory markers and bile acids were quantified.Measurements and Main ResultsWe observed three community composition profiles (labelled community state types, CSTs 1-3). Transplant recipients with GERD were more likely to have CST1, characterized by high bacterial density and relative abundance of the oropharyngeal colonizing genera Prevotella and Veillonella. GERD was associated with more frequent transition to CST1. CST1 was associated with lower per-bacteria inflammatory cytokine levels than the pathogen-dominated CST3. Time-dependant models revealed associations between CST3 and development of ALAD/CLAD. Nissen fundoplication decreased bacterial load and pro-inflammatory cytokines.ConclusionGERD was associated with a high bacterial density, Prevotella/Veillonella dominated CST1. CST3, but not CST1 or GERD, was associated with inflammation and early development of ALAD/CLAD. Nissen fundoplication was associated with decreases in microbial density in BALF samples, especially the CST1-specific genus, Prevotella.

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The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea

Journal of Fungi ◽

10.3390/jof7080639 ◽

2021 ◽

Vol 7 (8) ◽

pp. 639

Author(s):

Yae-Jee Baek ◽

Yun-Suk Cho ◽

Moo-Hyun Kim ◽

Jong-Hoon Hyun ◽

Yu-Jin Sohn ◽

...

Keyword(s):

Cohort Study ◽

South Korea ◽

Fungal Infection ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lung Transplant ◽

Fungal Infections ◽

Transplant Recipients ◽

Tertiary Center ◽

Lung Transplant Recipients

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.

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Gastroesophageal Reflux Disease and Idiopathic Lung Fibrosis. From Heartburn to Lung Transplant, and Beyond

The American Surgeon ◽

10.1177/0003134821998686 ◽

2021 ◽

pp. 000313482199868

Author(s):

Fernando A. M. Herbella ◽

Marco G. Patti

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Lung Fibrosis ◽

Bronchiolitis Obliterans ◽

Lung Transplant ◽

Ph Monitoring ◽

Objective Evaluation ◽

Bronchiolitis Obliterans Syndrome ◽

Laparoscopic Operation

Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other’s severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.

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