Long-Term Proton Pump Inhibitors in Lung Transplant Recipients: Near-Universal Use Without Clear Impact on Clinical Outcomes Over a 20-Year Observational Study.
Chen Yang Kevin Zhang, Rayoun Ramendra, Meghan Aversa, Rasheed Ghany, Jussi Tikkanen, Ella Huszti, Jonathan Yeung, Shaf Keshavjee, Lianne G Singer, Tereza Martinu
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引用次数: 0
Abstract
Background: Gastroesophageal reflux disease (GERD) is a known risk factor for chronic lung allograft dysfunction (CLAD), the main barrier to long-term survival in lung transplant recipients (LTR). While proton pump inhibitors (PPI) are effective for symptomatic treatment of GERD, data are sparse on the prevalence of long-term PPI use and association with clinical outcomes.
Methods: Single-center retrospective cohort of adult first-time LTR between 1999 to 2018 who were alive and CLAD-free at 1-year post-transplant. PPI exposure was defined as ≥8 continuous weeks in the first year, started within 6 months post-transplant.
Results: 1308 LTR were included, with 1170 (89.4%) exposed to PPI. PPI use increased over time and remained above 90% from 2007 onwards. In multivariable analyses, LTR on PPI had similar time to CLAD and time to death/retransplant compared to those not on PPI. Similarly, no differences in outcomes were observed between LTR on once-daily and twice-daily dosing, or after accounting for the number of reflux episodes on 24 h pH-impedance monitoring. Positive bronchoalveolar lavage cultures and acute rejection over the first-year post-transplant was also comparable.
Conclusions: Long-term use of PPI became near-universal without observable effect on clinical outcomes. While further research is needed, these findings question the routine use of PPI in LTR.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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