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Original Research: LUNG TRANSPLANTATION |

Surgical Correction of Gastroesophageal Reflux in Lung Transplant Patients Is Associated With Decreased Effector CD8 Cells in Lung Lavages: A Case Series

David C. Neujahr, MD; Aminu Mohammed, MD; Onome Ulukpo, BA; Seth D. Force, MD, FCCP; Allan M. Ramirez, MD; Andres Pelaez, MD; E. Clinton Lawrence, MD, FCCP; Christian P. Larsen, MD, DPhil; Allan D. Kirk, MD, PhD
Author and Funding Information

From the Department of Medicine (Drs Neujahr, Ramirez, Pelaez, and Lawrence), the Department of Pediatrics (Dr Mohammed), the Transplant Center (Ms Ulukpo and Drs Larsen and Kirk), and the Department of Surgery (Dr Force), Emory University School of Medicine, Atlanta, GA.

Correspondence to: David C. Neujahr, MD, Department of Medicine, Emory University School of Medicine, 1364 Clifton Rd, F520, Atlanta, GA 30322; e-mail: dneujah@emory.edu


Funding/Support: This work was supported by Roche Organ Transplant Research Foundation [Grant #631634718] to David C. Neujahr, principal investigator.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):937-943. doi:10.1378/chest.09-2888
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Background:  Lung transplantation is associated with a high incidence of gastroesophageal reflux disease (GERD). The presence of GERD is considered a risk factor for the subsequent development of obliterative bronchiolitis (OB), and surgical correction of GERD by gastric fundoplication (GF) may be associated with increased freedom from OB. The mechanisms underlying a protective effect from OB remain elusive. The objective of this study was to analyze the flow cytometric properties of BAL cells in patients who have undergone GF early after transplant.

Methods:  In a single-center lung transplant center, eight patients with GERD who were in the first transplant year underwent GF. Prior to and immediately following GF, BAL cells were analyzed by polychromatic flow cytometry. Spirometry was performed before and after GF.

Results:  GF was associated with a significant reduction in the frequency of BAL CD8 lymphocytes expressing the intracellular effector marker granzyme B, compared with the pre-GF levels. Twenty-six percent of CD8 cells were granzyme Bhi pre-GF compared with 12% of CD8 cells post-GF (range 8%-50% pre-GF, 2%-24% post-GF, P = .01). In contrast, GF was associated with a significant interval increase in the frequency of CD8 cells with an exhausted phenotype (granzyme Blo, CD127lo, PD1hi) from 12% of CD8 cells pre-GF to 24% post-GF (range 1.7%-24% pre-GF and 11%-47% post-GF, P = .05). No significant changes in spirometry were observed during the study interval.

Conclusions:  Surgical correction of GF is associated with a decreased frequency of potentially injurious effector CD8 cells in the BAL of lung transplant recipients.

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