Acid Suppression Results in a Decrease in Mortality for GERD Patients Following Lung Transplantation

Wai-Kit Lo, MD, MPH

Acid suppression could reduce the mortality risk for patients with gastroesophageal reflux disease (GERD) following lung transplantation in data presented during

A team, led by Wai-Kit Lo, Brigham and Women’s Hospital, examined clinical outcomes in lung transplantation with acid suppression therapy with proton pump inhibitor or histamine-2 receptor antagonist use with a particular focus on early mortality within 1 year.

GERD

GERD is often linked to allograft rejection and failure following lung transplantation. This ultimately increases the risk of mortality.

Antireflux surgery is known to modulate GERD-associated risk of poor transplant outcomes, but the role of medical reflux treatment with acid suppression in lung transplant patients is poorly defined and inconsistently applied across different centers.

In the retrospective cohort study, the investigators examined lung transplant recipients at a tertiary care center between 2007-2022. The team excluded patients with pre-transplant antireflux surgery.

The investigators sought outcomes of all-cause mortality and pulmonary mortality within 1 year of transplantation. They also obtained objective reflux data from per0transplant ambulatory reflux monitoring and applied time-to-event analysis using Cox proportional hazards models.

Participants not meeting the outcome were censored at death, last clinic visit, or Nissen fundoplication.

The investigators also assessed differences between treatment cohorts using Fisher’s exact test and student’s t-test.

The Study

They identified a total of 467 patients with similar demographics, comorbidities, and pre-transplant cardiopulmonary function.

Overall, 6% (n = 28) of the patients died within 1 year of transplantation, 4.7% (n = 22) because of pulmonary disease, with pneumonia being the most likely cause.

However, both post-transplant PPI and histamine-2 receptor antagonist use were independently associated with reduced risk of 1-year mortality because of pulmonary disease after controlling for confounders, including objective acid and nonacid reflux.

Post-transplant PPI use was associated with reduced all-cause mortality within the first year, but treatment with histamine-2 receptor antagonist was not.

“Acid suppression therapy with PPI or H2RA after lung transplantation was independently associated with decreased 1-year mortality,” the authors wrote. “These findings suggest that pharmacologic treatment of GER may have a role in the management of early mortality following lung transplantation.”

A key finding was the protective effects were independent of evidence of the disease, which shows the potential mechanisms beyond acid suppression alone, such as possible direct anti-inflammatory effect by PPI as suggested in prior in vitro studies.

“Further investigations are needed on more standard applications of acid suppression therapy in this patient population to improve outcomes,” the authors wrote.

The study, “Sa1189: ACID SUPPRESSION THERAPY IS INDEPENDENTLY ASSOCIATED WITH REDUCED RISK OF 1-YEAR MORTALITY FOLLOWING LUNG TRANSPLANTATION,” was published online by DDW 2022.