1
|
Ramendra R, Fernández-Castillo JC, Huszti E, Ghany R, Aversa M, Havlin J, Riddell P, Chaparro CM, Singer LG, Liu L, Keshavjee S, Yeung JC, Martinu T. Oesophageal stasis is a risk factor for chronic lung allograft dysfunction and allograft failure in lung transplant recipients. ERJ Open Res 2023; 9:00222-2023. [PMID: 37817870 PMCID: PMC10561084 DOI: 10.1183/23120541.00222-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/04/2023] [Indexed: 10/12/2023] Open
Abstract
Background Morbidity and mortality in lung transplant recipients are often triggered by recurrent aspiration events, potentiated by oesophageal and gastric disorders. Previous small studies have shown conflicting associations between oesophageal function and the development of chronic lung allograft dysfunction (CLAD). Herein, we sought to investigate the relationship between oesophageal motility disorders and long-term outcomes in a large retrospective cohort of lung transplant recipients. Methods All lung transplant recipients at the Toronto Lung Transplant Program from 2012 to 2018 with available oesophageal manometry testing within the first 7 months post-transplant were included in this study. Patients were categorised according to the Chicago Classification of oesophageal disorders (v3.0). Associations between oesophageal motility disorders with the development of CLAD and allograft failure (defined as death or re-transplantation) were assessed. Results Of 487 patients, 57 (12%) had oesophagogastric junction outflow obstruction (OGJOO) and 47 (10%) had a disorder of peristalsis (eight major, 39 minor). In a multivariable analysis, OGJOO was associated with an increased risk of CLAD (HR 1.71, 95% CI 1.15-2.55, p=0.008) and allograft failure (HR 1.69, 95% CI 1.13-2.53, p=0.01). Major disorders of peristalsis were associated with an increased risk of CLAD (HR 1.55, 95% CI 1.01-2.37, p=0.04) and allograft failure (HR 3.33, 95% CI 1.53-7.25, p=0.002). Minor disorders of peristalsis were not significantly associated with CLAD or allograft failure. Conclusion Lung transplant recipients with oesophageal stasis characterised by OGJOO or major disorders of peristalsis were at an increased risk of adverse long-term outcomes. These findings will help with risk stratification of lung transplant recipients and personalisation of treatment for aspiration prevention.
Collapse
Affiliation(s)
- Rayoun Ramendra
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Juan C. Fernández-Castillo
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Rasheed Ghany
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Meghan Aversa
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jan Havlin
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Peter Riddell
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Cecilia M. Chaparro
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Lianne G. Singer
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louis Liu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan C. Yeung
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tereza Martinu
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Dewey KG, Yang Z, Adu‐Afarwuah S, Brown KH, Chaparro CM, Cohen RJ, Domellof M, Hernell O, Lartey A, Lonnerdal B. Prevalence and predictors of iron deficiency in exclusively breastfed infants at 6 mo of age: comparison of data from 6 studies. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn G Dewey
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | - Z Yang
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | - S Adu‐Afarwuah
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | - K H Brown
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | - C M Chaparro
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | - R J Cohen
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| | | | - O Hernell
- Umeå UniversitySE‐901 85, UmeåSweden
| | - A Lartey
- Univ GhanaDept NutritionLegonGhana
| | - B Lonnerdal
- Univ CaliforniaDept NutritionUniv CaliforniaOne Shields AveDavisCA95616‐8669
| |
Collapse
|
4
|
Yang Z, Dewey KG, Lonnerdal BL, Hernell O, Chaparro CM, Adu‐Afarwuah S, McLean ER, Cohen RJ, Domellof M, Allen LH, Brown KH. Comparison of plasma ferritin concentration versus the ratio of plasma transferrin receptor/ferritin to estimate total body iron stores: results of four intervention trials. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a164-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Z Yang
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - K G Dewey
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - B L Lonnerdal
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - O Hernell
- Umea UniversityDepartment of Clinical SciencesUmeaSweden
| | - C M Chaparro
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - S Adu‐Afarwuah
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - E R McLean
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - R J Cohen
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - M Domellof
- Umea UniversityDepartment of Clinical SciencesUmeaSweden
| | - L H Allen
- USDA, ARS Western Human Nutrition Research CenterOne Shields AvenueDavisCA95616
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| | - K H Brown
- University of CaliforniaDavis, One Shields AvenueDavisCA95616
| |
Collapse
|