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Objective: 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., Methods: 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)., Results: 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)., Conclusions: 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., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Esophageal dysmotility and gastroesophageal reflux disease are common in patients with advanced lung disease and can potentially affect outcomes of lung transplant; however, the effects of lung transplant on foregut function remain unknown. We assessed foregut function before and after bilateral lung transplant., Methods: We attempted complete foregut function testing before and after lung transplant. We compared patients with obstructive lung disease and patients with restrictive lung disease who underwent lung transplant between 2015 and 2016., Results: In total, 112 patients met inclusion criteria. The mean age of patients was 62.2 years, and 62 patients were men. A total of 51 patients (45.5%) were diagnosed with obstructive lung disease, and 56 patients (50.0%) were diagnosed with restrictive lung disease. Approximately half of these patients had a change in manometric diagnosis before and after lung transplant, with most achieving increased peristaltic vigor. Pre-lung transplant gastroesophageal reflux disease was more prevalent in the restrictive lung disease cohort than in the obstructive lung disease cohort (42.9% vs 19.6%, P = .010). Thoracoabdominal pressure gradient before lung transplantation was greater in the restrictive lung disease group than in the obstructive lung disease group (23.4 vs 14.7 mm Hg, P < .001), which may explain the mechanism of increased reflux in patients with restrictive lung disease. No differences were seen in the post-lung transplant prevalence of pathological reflux and thoracoabdominal pressure gradient between groups., Conclusions: Esophageal motility and reflux parameters vary significantly between patients with obstructive lung disease and patients with restrictive lung disease, and can be explained by differences in underlying pulmonary dynamics. Restoring pulmonary physiology after lung transplant ameliorates the effects of esophageal dysmotility and reflux. Improved peristaltic vigor after lung transplant in patients with hypomotility is important, which may make them eligible for antireflux surgery if gastroesophageal reflux disease persists after lung transplant., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation. Fundoplication slows lung function decline in patients with GERD, but the optimal timing of fundoplication is unknown., Methods: We retrospectively reviewed patients who underwent fundoplication after lung transplantion at our center from April 2007 to July 2014. Patients were divided into 2 groups: early fundoplication (<6 months after lung transplantation) and late fundoplication (≥6 months after lung transplantation). Annual decline in percent predicted forced expiratory volume in 1 second (FEV 1 ) was analyzed., Results: Of the 251 patients who underwent lung transplantation during the study period with available pH data, 86 (34.3%) underwent post-transplantation fundoplication for GERD. Thirty of 86 (34.9%) had early fundoplication and 56 of 86 (65.1%) had late fundoplication. Median time from lung transplantation to fundoplication was 4.6 months (interquartile range, 2.0-5.2) and 13.8 months (interquartile range, 9.0-16.1) for the early and late groups, respectively. The median DeMeester score was comparable between groups. One-, 3-, and 5-year actuarial survival rates in the early group were 90%, 70%, and 70%, respectively; in the late group, these rates were 91%, 66%, and 66% (log rank P = .60). Three- and 5-year percent predicted FEV 1 was lower in the late group by 8.9% (95% confidence interval, -30.2 to 12.38; P = .46) and 40.7% (95% confidence interval, -73.66 to -7.69; P = .019). A linear mixed model showed a 5.7% lower percent predicted FEV 1 over time in the late fundoplication group (P < .001)., Conclusions: In this study, patients with early fundoplication had a higher FEV 1 5 years after lung transplantation. Early fundoplication might protect against GERD-induced lung damage in lung transplant recipients with GERD., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)