Pre-Lung transplant reflux testing demonstrates high prevalence of gastroesophageal reflux in cystic fibrosis and reduces chronic rejection risk

Table 1 Differences in demographics, transplant risk, reflux parameters, and post-transplant management between cystic fibrosis subjects receiving and not receiving pre-transplant gastroesophageal reflux evaluation, n (%)

Covariate	CF patients with pre-transplant reflux testing (n = 41)	CF patients without pre-transplant reflux testing (n = 19)	P value
Male gender	21 (51.2)	9 (47.4)	1.00
Age at lung transplant	35.8 ± 8.21	30.1 ± 7.89	0.01
Body mass index	20.4 ± 2.51	19.4 ± 1.97	0.11
Caucasian race	41 (100)	19 (100)	1.00
FEV1 before transplant	0.84 ± 0.36)	0.75 ± 0.22	0.24
LVEF before transplant	0.60 ± 0.05	0.59 ± 0.05	0.52
Bilateral lung transplant	41 (100)	19 (100)	1.00
CMV mismatch	15 (36.6)	6 (31.6)	0.78
High-risk donor	0	0	1.00
GER symptoms before transplant	22 (53.7)	5 (26.3)	0.06
Pre-transplant PPI use	27 (65.8)	16 (84.2)	0.22
Abnormal testing/Acid reflux	24 (58.4)	-
Post-transplant PPI use	34 (82.9)	17 (89.5)	0.70
Post-transplant Nissen fundoplication	8 (19.5)	0 (0)	0.05
Any infection	35 (85.4)	17 (89.5)	1.00
Acute rejection	12 (29.3)	7 (36.8)	0.56
Chronic rejection/CLAD	9 (21.9)	12 (63.1)	0.02
Death (All-cause)	8 (19.5)	8 (42.1)	0.11
Death (Pulmonary)	5 (12.2)	6 (31.6)	0.09

CF: Cystic fibrosis; FEV1: Forced expiratory volume in 1 second; LVEF: Left ventricular cardiac ejection volume; CMV: Cytomegalovirus; GER: Gastroesophageal reflux; PPI: Proton pump inhibitor; CLAD: Chronic lung allograft dysfunction.

Table 2 Cox multivariate time-to-event analysis demonstrating the association between pre-transplant reflux testing and reduction in chronic rejection (chronic lung allograft dysfunction) in cystic fibrosis patients, after controlling for confounders, suggesting that reflux testing and timely treatment may reduce rejection in this patient cohort

Covariate	Cox multivariate analysis hazard ratios for chronic lung allograft dysfunction	P
Pre-transplant reflux testing	0.26 (0.08-0.92)	0.03
Gastroesophageal reflux symptoms before transplant	3.13 (1.03-9.54)	0.04
Forced expiratory volume in 1 second before transplant	3.17 (0.61-16.4)	0.17
Body mass index	0.98 (0.75-1.28)	0.88
Age at transplant	0.98 (0.90-1.05)	0.54