B0461 - Rate of Upper Gastrointestinal Motility Disorders Post Lung Transplantation

Benjamin Yeager, MD¹, Emily Minor, MD¹, Mark Radlinski, MD², Alexander Podboy, MD^2
1University of Virginia Health System, Charlottesville, VA; ²University of Virginia, Charlottesville, VA

Introduction: Microaspiration of gastric contents is considered a risk factor for the development of bronchiolitis obliterans syndrome, the main cause of graft failure, late morbidity, and mortality following lung transplantation. Gastrointestinal motility disorders can lead to increased microaspiration events and are common post lung transplant, however their influence on allograft function has not fully been evaluated. Our aim was to assess the frequency of gastrointestinal motility disorders following lung transplantation as it relates to allograft rejection.

Methods: We conducted a retrospective chart review of patients who underwent lung transplantation within our institution between 1/1/2019 - 12/31/2021. Clinicodemographic, radiographic, endoscopic, manometric, pH testing, pulmonary function testing, and outcome data post-transplant was obtained.

Results: 75 patients underwent lung transplantation during the study period. 11 patients had evidence of allograft rejection. 2 of the 9 deaths throughout the study period were due to rejection. 50.0% of patients had delayed gastric emptying studies (GES). 57.1% had elevated pH testing. Of those with esophageal manometry (EMAN), 37.1% had abnormal findings. pH elevation, as measured by DeMeester scoring, was high in 71.4% of patients with allograft rejection (n=7) compared to 53.6% of those without rejection (n=28, p < 0.672). Mean DeMeester scores for those with and without rejection were 50.4 and 29.5, respectively.



Comparable rates were observed for delayed GES in addition to abnormal findings on EMAN for both patients with and without rejection. High rates of gastroparesis were identified with 66.7% for those with rejection (n=6) vs 46.4% for those without (n=28, p< 0.6562). The median 4-hour GES was 12.0. In those with delayed GES, the median was 20.0 for rejection vs 4.8 for those without. High resolution manometry noted abnormalities in 42.9% of patients with rejection (n=7) compared to 35.7% without (n=28, p=1).



Discussion: High rates of gastrointestinal motility disorders are seen post-transplant with delayed gastric emptying (50.0%), increased acid-exposure time (57.1%), and abnormal manometry (37.1%). However, there was not a statistically significant difference in pH testing, manometric, nor gastric emptying testing between patients who had allograft rejection (acute and chronic) vs normal graft function. Secondary to the rarity of allograft rejection, larger, likely multicenter studies evaluating this association may be warranted.



Disclosures:


Benjamin Yeager, MD¹, Emily Minor, MD¹, Mark Radlinski, MD², Alexander Podboy, MD². B0461 - Rate of Upper Gastrointestinal Motility Disorders Post Lung Transplantation, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.