Predictors and Outcomes among Patients with Early Swallow Dysfunction after Lung Transplantation

PURPOSE: To evaluate the patient characteristics, associated variables and early and late outcomes among patients with swallow dysfunction on modified barium swallow study (MBSS) after lung transplantation (LT). METHODS: This was a retrospective study that included patients transplanted between 2012- 2015 (n=257, mean age 58±13 years, M:F 165: 92). We reviewed baseline characteristics, and findings on MBSS done as part of the post-transplant assessment of swallow function. We also reviewed the pre and post LT course including morbidity and mortality endpoints. RESULTS: A completely normal swallow evaluation on MBSS was unusual (n=60, 23.3%) with laryngeal penetration as the most commonly encountered abnormality (n=187, 72.8%) following by oropharyngeal pooling of secretions (n=72, 28%). Aspiration was noted in nearly one-fifth of the study group (50/257). Baseline demographics, co-morbidities, underlying diagnosis, or LAS were not associated with aspiration on post-LT MBSS. Patients bridged to transplant on mechanical ventilation (42.9% vs 17.4%; OR: 3.6, 1.4-9; p=0.005) had increased risk of aspiration. None of the post-operative variables such as primary graft dysfunction, duration of intubation after LT, ICU or hospital length of stay were associated with aspiration. Although patients with aspiration had worse one-yr (16% vs 5.8%; OR,95%CI: 3.1, 1.19-8.06; p=0.016, see Figure) and possibly 3-yr mortality (36% vs 23.7%; OR,95%CI: 1.8, 0.94-1.19; p=0.07), CLAD free survival at 3-yr was similar (48.8% vs 55.3%). CONCLUSION: Development of swallow dysfunction is common after LT surgery. While mild dysphagia, as reflected by the finding of laryngeal penetration, is the most common abnormality, a significant proportion of patients demonstrate frank aspiration. None of the pre-transplant or peri-transplant variables reliably predict post-LT aspiration risk. Despite similar morbidity outcomes early on, patients with aspiration may experience worse one-year survival.