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Background/Aims: Gastroesophageal reflux (GER) and subsequent aspiration events are hypothesized to be potential contributors to chronic allograft dysfunction in lung transplant recipients. There are limited data on changes in GER or esophageal motility post-transplantation. We hypothesized that patients who had undergone lung transplantation would be predisposed to increased reflux events. Methods: Prospective comparative series of 19 pretransplant patients (47% female) and 13 post-transplant patients (23% female) being evaluated for GER. All patients were on regular acid suppression. After informed consent, patients filled out a detailed GER symptom questionnaire. Thereafter, both groups underwent esophageal manometry and 24hour catheter pH monitoring. Results: Mean age was similar between groups (Pre: 55yrs, 95% CI: 49-60; Post: 53yrs, 95% CI: 47-58. p= 0.65) . Cause of lung disease was also similar between groups (interstitial lung disease: 9/19 patients pre, 4/13 post. COPD: 7/19 patients pre, 4/13 post). No differences in esophageal manometry, including baseline lower esophageal sphincter (LES) pressures (Pre-transplantation: 12.5 mmHg, 95% CI: 9.5-16.0. Post transplant: 9.0, 95% CI: 5.0-12.9. p=0.13) and percent LES relaxation (Pre-transplant: 76%, 95% CI: 63-88. Post transplant: 70%, 95% CI: 58-83, p= 0.28) were observed between the two groups. Patients post-lung transplantation had a significantly increased total time spent in reflux over the 24 hour study period, as well as a significantly increased number of reflux episodes over five minutes (Table). There was a trend towards an increase in the DeMeester score in patients post-lung transplantation. Conclusion: This hypothesis-generating study suggests that post-lung transplant patients have more prolonged reflux episodes and total time spent in reflux compared to pretransplant candidates, via a mechanism independent of altered esophageal motility.