[Gastroesophageal reflux as a cause of pulmonary dysfunction after lung transplantation].

Gastroesophageal reflux is a potential cause of allograft dysfunction after lung transplantation due to microaspiration, lung inflammation, and development of bronchitis obliterans. A 16-year-old Japanese boy who had been suffering from interstitial lung disease received bilateral lung transplant from a braindead donor in the United States. Three months after lung transplantation, his lung function has not increased as expected. Spirometory revealed forced vital capacity (FVC) of 1.11 l (33% of predicted) and forced expiratory volume in one second (FEV1.0) of 0.81 l (28% of predicted). All possible etiologies, including infection, acute and chronic rejection, and other abnormalities were investigated. The only positive finding was the presence of gastroesophageal reflux. He first underwent pyroloplasty which did not improve lung function. Twenty-four-hour pH monitor performed after surgery revealed frequent gastroesophageal reflux. He eventually underwent laparoscopic fundoplication 9 months after initial lung transplantation. His lung function gradually improving after fundoplication, an FVC was 1.56 l (44% of predicted) and FEV1 was 1.25 l (33% of predicted).