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Background: Gastroesophageal reflux disease (GERD) is highly prevalent after lung transplantation (LTx) and is suspected to favor the development of chronic lung allograft dysfunction (CLAD), almost of bronchiolitis obliterans syndrome (BOS) phenotype. The preventive effect of antireflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort. Methods: Data from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry. Results: Among 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p = 0.03). An increase in donor-specific antibodies' mean fluorescence intensity values was observed only in GERD after LTx (M6 vs day 0, p

Background Calcineurin inhibitors (CNIs) remain the cornerstone of maintenance immunosuppression (IS) after lung transplantation (LTx), although CNI-related life-threatening toxic effects may occur. Belatacept, a novel immunosuppressant that blocks a T-cell co-stimulation pathway, is a non-nephrotoxic drug indicated as an alternative to CNIs in kidney Tx. In LTx, there are only a few reports of belatacept conversion as a CNI-free or CNI-sparing IS treatment. Methods We reviewed a series of 10 LTx recipients with conversion to a CNI-free belatacept IS regimen within the first year post-LTx (n = 7) or a belatacept/low-dose CNI combination after the first year (n = 3). Results Use of belatacept was triggered by severe renal failure in 9 patients and under-IS with previous other IS-related toxicities in 1 patient. Mean estimated glomerular filtration rate after starting belatacept significantly improved at 6 months after initiation and at the last-follow-up (p = 0.006, and p = 0.002 respectively). The incidence of recurrent and/or severe acute cellular rejection (ACR) episodes was high in patients with CNI-free belatacept-based IS (n = 4/7). Chronic graft allograft dysfunction developed in 2 of 9 recipients under belatacept IS. Belatacept was stopped in 6 patients because of recurrent/severe ACR (n = 3), recurrent opportunistic infections (n = 1), center modified policy (n = 1), or other cause (n = 1). Conclusion Early conversion to CNI-free belatacept-based IS improved renal function in this series but was counterbalanced by a high incidence of recurrent ACR, including life-threatening episodes. Other studies are needed to better determine the indications for its use after LTx, possibly with lower immunological risk IS regimens, such as CNI-sparing belatacept.