Abstract
Introduction: Lung transplant (LT) recipients commonly have adverse gastrointestinal (GI) events in the post-transplant period and require multidisciplinary management including GI consultations. Presently, limited published information exists regarding the frequency and indication of such consultations. We aimed to review incidence of GI consults following LT and its impact on resource utilization. Methods: Retrospective analysis of inpatient database of consecutive patients undergoing LT from January 2015 to September 2017 as part of a QI project. Timing of consultation was categorized into early(<30 days), intermediate(<1 year) and late (>1 year). Results: 119 patients(mean age 62.9 years (SE 1.02); 56% men), who underwent LT(n = 113, 95% bilateral LT) for various indications(38% for COPD, 34% for idiopathic pulmonary fibrosis, 26% miscellaneous including cystic fibrosis and re-transplantation) were analyzed. A total of 186 inpatient GI consultations were performed as 49 patients had >1 consultations. Of these, 14%(n = 27) were early consultations, 63% were intermediate and 43% were late. Reason for consult was categorized as - esophageal(reflux, dysphagia; n = 43, 21%), gastroparetic(nausea, vomiting, abdominal pain; n 17, 9%) and acute emergencies(GI bleeding in 6.5% and acute ileus in 10%). 83% of consults related to esophageal and gastric dysmotility were seen after the first month (p < 0.05) while 56% of the emergent consults were encountered within the first month after LT. Almost half of the consults were for elective endoscopic procedures such as surveillance for history of polyps, Barrett's esophagus and malignancy. During this period, a total of 28 colonoscopies, 126 EGD and 5 advanced procedures (ERCP/EUS) were done. Only 2 major adverse events including aspiration and persistent desaturation requiring mechanical ventilation, were encountered. Only one case of mortality, not directly related to GI issues, was encountered. Conclusion: GI consultations are frequently encountered after LT. In comparison to usual inpatient consultations, esophageal and gastric dysmotility related symptoms are more common in this population resulting in high resource utilization. Endoscopic procedures are often performed in this population and are generally safe without any risk of adverse events. At least half of these consult requests are for endoscopic procedures which could potentially be performed in an outpatient setting.