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Risk Factors and Outcomes for Gastroparesis After Lung Transplantation

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An Editorial to this article was published on 15 September 2021

Abstract

Background

Gastroparesis is common after lung transplantation and is associated with worse transplant outcomes, including the development of chronic lung allograft dysfunction (CLAD). This study sought to identify the prevalence, risk factors, and outcomes associated with a new diagnosis of gastroparesis after lung transplantation.

Methods

This was a single-center retrospective study of patients who underwent lung transplantation in 2008–2018. The primary outcome was a new diagnosis of gastroparesis within 3 years of transplant. Secondary outcomes included a new diagnosis of gastroesophageal reflux and the association between gastroparesis and both post-transplant survival and CLAD-free survival. Multivariable logistic regression was used to compare diagnosis of gastroparesis and gastroesophageal reflux, while multivariable Cox proportional hazards models were used to analyze gastroparesis and post-transplant outcomes.

Results

Of 616 patients with no prior history of gastroparesis, 107 (17.4%) were diagnosed with delayed gastric emptying within 3 years of transplant. On multivariable logistic regression, black race (OR 2.16, 95% CI 1.18–3.98, p = 0.013) was significantly associated with a new diagnosis of gastroparesis. Age, sex, history of diabetes, connective tissue disease, type of transplant, diagnosis group, renal function, and body mass index were not predictive of gastroparesis post-transplant. Gastroparesis was significantly associated with CLAD (HR 1.76, 95% CI 1.20–2.59, p = 0.004), but not with overall mortality (HR 1.16, p = 0.43).

Conclusion

While gastroparesis is common after lung transplantation, it remains difficult to predict which patients will develop these complications post-transplant. Black patients were more likely to be diagnosed with gastroparesis after adjusting for relevant confounders. Gastroparesis is associated with increased risk of CLAD, and further studies are needed to assess whether early detection and treatment can reduce the incidence of CLAD.

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Abbreviations

CLAD:

Chronic lung allograft dysfunction

GERD:

Gastroesophageal reflux disease

FEV1:

Forced expiratory volume at 1 s

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, 622 West 168th Street, New York, NY, USA

    John W. Blackett & Daniela Jodorkovsky

  2. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA

    Luke Benvenuto & Selim Arcasoy

  3. Division of Cardiac, Vascular, and Thoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center, New York, NY, USA

    Miguel M. Leiva-Juarez & Frank D’Ovidio

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  1. John W. Blackett
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Contributions

Study concept and design were contributed by JWB, LB, SA, DJ. Acquisition of data was contributed by JWB, MLJ, FD. Analysis and interpretation of data were contributed by JWB, LB, DJ. Drafting of the manuscript was contributed by JWB, LB, SA, DJ. Critical revision of the manuscript for important intellectual content was contributed by JWB, LB, MLF, FD, SA, DJ.

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Correspondence to John W. Blackett.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Columbia University approved this study.

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Guarantor of article: Daniela Jodorkovsky.

An editorial commenting on this article is available at https://doi.org/10.1007/s10620-021-07251-4.

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Blackett, J.W., Benvenuto, L., Leiva-Juarez, M.M. et al. Risk Factors and Outcomes for Gastroparesis After Lung Transplantation. Dig Dis Sci 67, 2385–2394 (2022). https://doi.org/10.1007/s10620-021-07249-y

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