Oropharyngeal Dysphagia and Laryngeal Dysfunction in Heart and Lung Transplantation

Abstract

Heart and lung transplantation is the optimal treatment modality for end-stage heart and lung failure. Despite its benefits, it carries risks such as primary graft failure, rejection, infection, and multiorgan dysfunction. Lesser-known complications like oropharyngeal dysphagia (OPD) and laryngeal dysfunction can significantly affect patient outcomes and quality of life. However, these issues remain under-researched.

This thesis addresses the gap with four peer-reviewed studies. A systematic review (Chapter 2) found limited data, but high rates of OPD (>70%) were reported. Chapter 3 offers the first comprehensive overview of the mechanisms, diagnosis, and management of swallowing and laryngeal dysfunction after transplant.

The reviews confirm that swallowing and laryngeal complications following transplantation are common and impactful, yet clinical guidance is lacking. To address this, a retrospective study (Chapter 4) investigated indicators for speech-language pathology referral and a prospective study (Chapter 5) followed patients through the transplant journey, trialling a novel assessment protocol. Our preliminary data revealed elevated self-reports of swallowing and voice difficulties pre-operatively, however baseline aspiration was not evident.

Chapter 6 introduces an online education series to guide clinicians in managing swallowing and laryngeal complications in this population, while chapter 7 discusses clinical implications and future directions.

In summary, this thesis identifies the frequency, risk factors, and profile of OPD and laryngeal dysfunction in cardiopulmonary transplant patients. The findings lay the groundwork for future research and development of clinical guidelines to improve outcomes while minimizing patient burden.