Clinical Transplantation · Oct 2026

Long-Term Proton Pump Inhibitors in Lung Transplant Recipients: Near-Universal Use Without Clear Impact on Clinical Outcomes Over a 20-Year Observational Study

By Zhang CYK, Ramendra R, Aversa M et al.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a known risk factor for chronic lung allograft dysfunction (CLAD), the main barrier to long-term survival in lung transplant recipients (LTR). While proton pump inhibitors (PPI) are effective for symptomatic treatment of GERD, data are sparse on the prevalence of long-term PPI use and association with clinical outcomes. METHODS: Single-center retrospective cohort of adult first-time LTR between 1999 to 2018 who were alive and CLAD-free at 1-year post-transplant. PPI exposure was defined as ≥8 continuous weeks in the first year, started within 6 months post-transplant. RESULTS: 1308 LTR were included, with 1170 (89.4%) exposed to PPI. PPI use increased over time and remained above 90% from 2007 onwards. In multivariable analyses, LTR on PPI had similar time to CLAD and time to death/retransplant compared to those not on PPI. Similarly, no differences in outcomes were observed between LTR on once-daily and twice-daily dosing, or after accounting for the number of reflux episodes on 24 h pH-impedance monitoring. Positive bronchoalveolar lavage cultures and acute rejection over the first-year post-transplant was also comparable. CONCLUSIONS: Long-term use of PPI became near-universal without observable effect on clinical outcomes. While further research is needed, these findings question the routine use of PPI in LTR.

doi.org/10.1111/ctr.70706Open accessPubMed 42878165Populations