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Acid Reflux Surgery Could Help Prevent Rejection in Lung Transplant Patients, Loyola Study Finds

MAYWOOD, Ill. - A Loyola University Medical Center study suggests that a procedure to treat acid reflux can help prevent chronic rejection in lung transplant patients.
The study also found that certain proteins found in lung fluid can help predict whether a patient’s transplanted lung is more likely to fail.

Results were published in the July 2013 issue of the Journal of the American College of Surgeons.  Authors are P. Marco Fisichella, MD, FACS (first author); Christopher S. Davis, MD, MPH; Erin Lowery, MD, MS; Luis Ramirez, BS; Richard L. Gamelli, MD, FACS; and Elizabeth J. Kovacs, PhD.

Lung transplant patients have the worst survival rates of all solid organ transplant recipients. A major reason is bronchiolitis obliterans syndrome (BOS). With this condition, scar tissue forms around small airways in the lungs. BOS results from chronic rejection of the transplanted lung and affects about half of lung transplant patients within five years.

Following lung transplantation, patients undergo a procedure every few months to inspect the airways. The procedure, called a bronchoscopy, removes fluid from the lung.

Loyola researchers analyzed various biomarkers of lung fluid obtained during bronchoscopies. Researchers found that in patients examined six to 12 months after transplant, concentrations of certain biomarkers could predict the likelihood of BOS 30 months after transplant. For example, patients with high concentrations of the biomarker myeloperoxidase and low concentrations of the biomarker α-1 antitrypsin were more likely to develop BOS.

The study also found that patients who aspirate (inhale fluid into the lungs) show evidence of a more active immune system. In a condition called acid reflux, gastric contents back up from the stomach into the esophagus and can be inhaled into the lungs. The gastric contents irritate the lungs, triggering the immune system to ramp up and begin rejection of the transplanted lung. As evidence of this, patients who aspirate showed higher levels of neutrophils (a type of immune system white blood cell) and the immune system biomarker interleukin-8 (IL-8).

A minimally invasive procedure called laparoscopic anti-reflux surgery can treat acid reflux. The surgeon reinforces the valve between the esophagus and stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus. The 90-minute procedure requires five small incisions. Patients typically go home the next day and take about one week to recover, Fisichella said.
Researchers wrote that their findings “justify the surgical prevention of aspiration and argue for the refinement of anti-rejection regimens.”

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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