S865 Impact of Pre-Transplant Esophageal Findings on Lung Transplant Outcomes: A Single-Center Retrospective Cohort Study

Introduction: Chronic lung allograft dysfunction (CLAD) is the leading cause of late morbidity and mortality following lung transplantation. Gastroesophageal reflux disease (GERD) and esophageal dysmotility have been implicated as potential contributors to CLAD. Comprehensive pre-transplant esophageal evaluation is routinely performed in many centers, but whether it predicts rejection or mortality remains uncertain. The primary aim of this study was to evaluate if motility or reflux abnormalities may impact the development of CLAD post-transplant. Methods: This retrospective cohort study included adults (≥18 years) undergoing lung transplant at a tertiary center (July 2020-July 2024). Data from electronic records included demographics, transplant details, pre-transplant reflux, and motility testing. Esophageal findings were defined as GERD and/or esophageal dysmotility. Primary outcome was development of CLAD; secondary outcomes included acute rejection (AR), time to CLAD/AR, and survival. Statistical analyses included competing risk models and survival analysis. Results: Among 162 lung transplant recipients (median age 64 years, 48% women, 86% White), 54% had a pre-transplant esophageal finding detected in either esophagogastroduodenoscopy, high-resolution manometry, or 24-hour pH-impedance. At 2 years post-transplant, cumulative incidence of CLAD was 88%, with no significant difference by esophageal finding status (GERD [+] vs [-]: 84% vs 91% [P = 0.39]; dysmotility [+] vs [-]: 88% vs 85% [P = 0.79]). AR occurred in 28%, similarly unaffected by esophageal finding (hazard ratio 2.00; 95% confidence interval 0.75-5.21; P = 0.17). One- and 3-year survival estimates did not differ significantly between groups (1-year: 86% vs 90%, 3-year: 78% vs 77%, P = 0.89). Median time to CLAD was approximately 146 days. Conclusion: More than half of the patients had a pre-transplant esophageal finding in our cohort. However, they were not associated with increased risk of CLAD, AR, or reduced survival post-transplant. These findings challenge the prevailing view that GERD and motility abnormalities independently worsen lung transplant outcomes. Additional evaluation is necessary to elucidate if specific motility findings, or reflux metrics are more likely than others to contribute to the development of CLAD or AR.