TY - JOUR T1 - Improving outcomes after thoracic surgery and lung transplant JF - Thorax JO - Thorax SP - A10 LP - A12 VL - 63 IS - Suppl 7 A2 - , Y1 - 2008/12/01 UR - http://thorax.bmj.com/content/63/Suppl_7/A10.abstract N2 - R Stovold, IA Forrest, DM Murphy, GE Johnson, J Lordan, AJ Fisher, PA Corris, JP Pearson, C Ward. Newcastle University, Newcastle upon Tyne, UKIntroduction: Aspiration may contribute to non-alloimmune lung allograft injury and eventual graft loss. Medical and surgical interventions have been advocated including fundoplication, but there is no current consensus about when this should be carried out. Biomarker approaches, including measuring pepsin1 and bile salts2 have been proposed to document aspiration and may potentially inform treatment, but there are few longitudinal studies.Hypothesis: Pepsin is present in serial bronchoalveolar lavage (BAL) samples from lung allograft recipients. High levels early post-lung transplant may be a practicable guide/rationale for early therapeutic intervention.Methods: Ten lung allograft recipients without bronchiolitis obliterans syndrome (three male, median age 43 years, range 20–61, two with an episode of clinical infection, one aspergillus and one pneumococcus) underwent longitudinal bronchoscopy and standardised BAL with transbronchial biopsy to assess rejection. BAL samples taken at one week, one month, 3 months, 6 months and a year were analysed for pepsin using an ELISA specific for pepsin.Results: Pepsin was detectable in variable amounts in all patients including high levels early posttransplantation. The figure plots this, and broken lines highlight three patients with early elevated levels. These three patients also had clinically significant (A2) acute vascular rejection, concordant with elevated pepsin, but no evidence of clinical infection. There was a trend towards higher pepsin levels (mean ± SEM) in patients with early A2 or greater rejection 26.7 ng/ml (±8.2), compared with patients with lesser grades of rejection 14.9 ng/ml (±3.3), p = NS.Abstract S18 FigureConclusions: Aspiration may be an ongoing injury to lung allografts. High levels of pepsin, detectable in some individuals early posttransplantation suggest a need to consider early treatment interventions. This is supported by other clinical work in … ER -