PMID- 29094310
OWN - NLM
STAT- MEDLINE
DCOM- 20180522
LR  - 20181113
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 63
IP  - 2
DP  - 2018 Feb
TI  - Proton Pump Inhibitors Independently Protect Against Early Allograft Injury or 
      Chronic Rejection After Lung Transplantation.
PG  - 403-410
LID - 10.1007/s10620-017-4827-0 [doi]
AB  - BACKGROUND: Acid reflux has been associated with poor outcomes following lung 
      transplantation. Unlike surgical fundoplication, the role of noninvasive, 
      pharmacologic acid suppression remains uncertain. AIMS: To assess the 
      relationship between post-transplant acid suppression with proton pump inhibitors 
      (PPI) or histamine-2 receptor antagonists (H2RA) and onset of early allograft 
      injury or chronic rejection following lung transplantation. METHODS: This was a 
      retrospective cohort study of lung transplant recipients at a tertiary center in 
      2007-2014. Patients with pre-transplant antireflux surgery were excluded. 
      Time-to-event analysis using the Cox proportional hazards model was applied to 
      assess acid suppression therapy and onset of acute or chronic rejection, defined 
      histologically and clinically. Subgroup analyses were performed to assess PPI 
      versus H2RA use. RESULTS: A total of 188 subjects (60% men, mean age 54, 
      follow-up 554 person-years) met inclusion criteria. During follow-up, 115 
      subjects (61.5%) developed rejection, with all-cause mortality of 27.6%. On 
      univariate analyses, acid suppression and BMI, but not other patient 
      demographics, were associated with rejection. The Kaplan-Meier curve demonstrated 
      decreased rejection with use of acid suppression therapy (log-rank p = 0.03). On 
      multivariate analyses, acid suppression (HR 0.39, p = 0.04) and lower BMI (HR 
      0.67, p = 0.04) were independently predicted against rejection. Subgroup analyses 
      demonstrated that persistent PPI use was more protective than H2RA or no 
      antireflux medications. CONCLUSIONS: Post-lung transplant exposure to persistent 
      PPI therapy results in the greatest protection against rejection in lung 
      transplant recipients, independent of other clinical predictors including BMI, 
      suggesting that PPI may have antireflux or anti-inflammatory effects in enhancing 
      allograft protection.
FAU - Lo, Wai-Kit
AU  - Lo WK
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis Street, Boston, MA, 02115, USA.
AD  - Department of Gastroenterology, Boston VA Healthcare System, Boston, MA, USA.
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Goldberg, Hilary J
AU  - Goldberg HJ
AD  - Harvard Medical School, Boston, MA, USA.
AD  - Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 
      Boston, MA, USA.
FAU - Boukedes, Steve
AU  - Boukedes S
AD  - Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 
      Boston, MA, USA.
FAU - Burakoff, Robert
AU  - Burakoff R
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis Street, Boston, MA, 02115, USA.
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Chan, Walter W
AU  - Chan WW
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis Street, Boston, MA, 02115, USA. wwchan@bwh.harvard.edu.
AD  - Harvard Medical School, Boston, MA, USA. wwchan@bwh.harvard.edu.
LA  - eng
PT  - Journal Article
DEP - 20171101
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Dig Dis Sci. 2018 Feb;63(2):411. PMID: 29282634
CIN - Dig Dis Sci. 2018 Dec;63(12):3518-3519. PMID: 30276567
MH  - Adult
MH  - Aged
MH  - Female
MH  - Graft Rejection/*prevention & control
MH  - Humans
MH  - Lung/pathology
MH  - Lung Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Proton Pump Inhibitors/*pharmacology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Gastroesophageal reflux
OT  - Graft rejection
OT  - Histamine H2 antagonists
OT  - Lung transplantation
OT  - Proton pump inhibitors
EDAT- 2017/11/03 06:00
MHDA- 2018/05/23 06:00
CRDT- 2017/11/03 06:00
PHST- 2017/09/17 00:00 [received]
PHST- 2017/10/23 00:00 [accepted]
PHST- 2017/11/03 06:00 [pubmed]
PHST- 2018/05/23 06:00 [medline]
PHST- 2017/11/03 06:00 [entrez]
AID - 10.1007/s10620-017-4827-0 [pii]
AID - 10.1007/s10620-017-4827-0 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2018 Feb;63(2):403-410. doi: 10.1007/s10620-017-4827-0. Epub 2017 
      Nov 1.