Gastroesophageal reflux (GER) and pretransplant antibodies against lung self-antigens
(SAbs) collagen-V and/or k-alpha 1 tubulin are both independently associated with
allograft dysfunction after lung transplantation (LTx). The role of GER in inducing
lung injury and SAbs is unknown. We aimed to study the association between pre-LTx
GER and SAbs. After IRB approval, we retrieved SAb assays conducted between 2015 and
2019 and collected 24 hour GER data for these patients. Patients were divided into
2 groups: no reflux (GER–) and pathologic reflux (GER+) to compare the prevalence
of SAbs. Multivariate analysis was used to study the association between GER and SAbs
in the whole cohort and in restrictive lung disease (RLD) and obstructive lung disease
(OLD) subsets. Proximal esophageal reflux (PER) events ≥5 was considered abnormal.
Patients (n = 134; 73 men) were divided into groups: GER– (54.5%, n = 73) and GER+
(45.5%, n = 61). The prevalence of GER was higher in the RLD than in the OLD subset
(p < 0.001). The overall prevalence of SAbs was 53.7% (n = 72), higher in the GER+
than the GER– group (65.6% vs 43.8%, p = 0.012), but comparable between RLD and OLD
subsets. Overall, SAbs were associated with GER (p = 0.012) and abnormal PER (p = 0.017).
GER and abnormal PER increased the odds of SAbs in the RLD subset (OR [95% CI]: 2.825
[1.033-7.725], p = 0.040 and OR [95% CI]: 3.551 [1.271-9.925], p = 0.014, respectively)
but not in the OLD subset. LTx candidates have a high prevalence of SAbs, which are
significantly associated with GER and abnormal PER in patients with RLD.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AET (acid exposure time), BOS (bronchiolitis obliterans syndrome), Col-V (collagen type-V), ELISA (enzyme-linked immunosorbent assay), GER (gastroesophageal reflux), IQR (interquartile range), Kα1T (k-alpha 1 tubulin), LTx (lung transplantation), OLD (obstructive lung diseases), OR (odds ratio), PER (proximal esophageal reflux), RLD (restrictive lung diseases), SAbs (antibodies against lung self-antigens collagen-V and/or k-alpha 1 tubulin)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 14, 2022
Footnotes
Accepted for the 46th annual meeting of the Western Thoracic Surgical Association.
Institutional Review Board Number: PHXB-16-0027-10-18. IRB Approval Date: 03/07/2016, with 12-month review cycle. Written patient consent for the publication of the study data was waived by the IRB because this was a retrospective data review only with no identifiable patient information.
Presentation Information: This data was accepted as a podium presentation at the Western Thoracic Surgical Association, June 2020 in Vail, Colorado.
Funding: Supported in part by a grant from the National Institutes of Health (NIH HL056643; principal investigator: Thalachallour Mohanakumar).
Conflicts of Interest: The authors have nothing to disclose with regards to commercial support.
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Access this article on ScienceDirectLinked Article
- Commentary: Rethinking the Role of Gastroesophageal Reflux in Lung Transplant CandidatesSeminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
- PreviewChronic lung allograft dysfunction (CLAD) is the leading cause of death in the first year following lung transplantation. Gastroesophageal reflux (GER) is among one of the several risk factors for the development of CLAD.1 Early studies suggest a protective effect of anti-reflux surgery on long term transplant outcomes, especially when performed soon after lung transplantation.2–4 Accordingly, it is acknowledged that antibodies against lung self-antigens (SAbs) play an important role in determining transplant outcomes.
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