S823 Impact of Sleep Positioning Device on Acid Exposure and Outcomes in Lung Transplant Recipients With Gastroesophageal Reflux Disease

Introduction: Gastroesophageal reflux disease (GERD) plays an important role in lung transplant (LT) outcomes. This study aims to evaluate the impact of a novel sleep positioning device (SPD) on lung function in LT recipients with GERD. Methods: In this single center cohort study, LT recipients (2014-2019) with GERD who were prescribed an SPD 2 years of LT were included. A historical control group of LT recipients with GERD on proton pump inhibitors only (2011-2013) was selected to compare forced expiratory volume in 1 second (FEV1) as a marker of lung function. Results: Twenty LT recipients using SPD (cases) and 54 patients in the historical control group with proven GERD were included. Mean (standard deviation [SD]) interval between LT and SPD prescription was 8.6 (5.7) months. Mean percent predicted FEV1 was higher in SPD users than controls post-LT at 6 months (80% vs 69%) and 1 year (80% vs 71%) respectively. Among SPD users, post-SPD FEV1 was higher than pre-SPD FEV1 (82% vs 70%). Ambulatory pH monitoring was performed pre- and post-SPD use in 15 patients. Acid exposure time in the supine position decreased significantly after SPD use when compared to pre-SPD readings (median 2.2% vs 15%, P < 0.0001); total acid exposure time also decreased significantly with SPD use (median 4.3% vs 11%, P = 0.015). Supine reflux resolved in 11 of 15 (73.1%) patients. Conclusion: Use of a novel SPD can stabilize or improve pulmonary function in patients with GERD after LT. SPD may be a safe and cost-effective adjunctive therapy for management of GERD after LT.