Mokahal, A El

Abstract Rationale In the early post-lung transplant period, close surveillance is essential to detect allograft dysfunction, infection, or medication toxicity. This requires frequent in-person clinic visits and laboratory testing, creating substantial travel and time burdens for patients and caregivers. Remote patient monitoring (RPM), which uses devices to collect and transmit physiologic and symptom data to the care team, has the potential to reduce geographic barriers and enable earlier detection of changes in patient status. Understanding the feasibility, adherence, and clinical impact of RPM is essential before broader implementation. Methods The Chronic Lung Allograft Monitoring (CLAM) program was launched in August 2024 at our center. Participants were provided a tablet and devices (spirometer, pulse oximeter, scale, and blood pressure cuff) to submit daily physiologic and symptom data. Abnormal parameters triggered review by RPM nurses and escalation to transplant physicians according to protocol. After 12 months of monitoring, patients were transitioned to self-monitoring when clinically appropriate. Demographics, compliance, and escalation characteristics were summarized descriptively. An escalation was defined as any entry triggering an alert to the transplant team. Escalations were categorized by cause and reviewed to determine clinical impact. Results Among 105 enrolled patients, the median age was 64 (IQR 58-68) years, 66 (63%) were male. 70 (67%) remain enrolled, 22 (21%) graduated, and 13 (12%) discontinued monitoring prematurely. reasons for discontinuation included death (n = 7; 7%), patient preference (n = 3; 3%), and non-adherence (n = 3; 3%), yielding an overall dropout rate of 5.7%. Completion rates were 64% for vital sign and spirometry submissions and 91% for symptom questionnaires.There were 395 escalations, with a median of 3 per patient (IQR 1-6); 82 patients (78%) experienced at least one escalation. Causes of escalations are summarized in Figure 1. Of all escalations, 282 (71%) were managed with continued monitoring, while 113 (29%) resulted in changes in care. Seven escalations (1.8%) led to emergency department evaluation and 2 (0.5%) resulted in direct hospital admission. Among non-emergent escalations, 35 (8.8%) prompted expedited clinic visits; of the remainder, 42 (10.6%) led to diagnostic testing orders and 32 (8.0%) resulted in medication initiation or adjustment. Conclusions RPM after lung transplantation was feasible, well accepted, and frequently informed clinical decision-making. The CLAM program demonstrates high engagement and clinical utility, supporting further prospective evaluation of RPM in lung transplant care. This abstract is funded by: None

Abstract Rationale Gastroesophageal reflux disease (GERD) is a common comorbidity in non-cystic fibrosis bronchiectasis (NCFB), yet its impact on clinical outcomes remains poorly defined. We sought to determine whether GERD is associated with worse clinical outcomes in patients with NCFB using a large, real-world database. Methods We conducted a retrospective cohort study using the TriNetX platform, identifying patients with NCFB (ICD-10 J47*) with and without concurrent GERD (ICD-10 K21*), excluding those with cystic fibrosis (ICD-10 E84*). Propensity score matching (PSM) was performed using 1:1 nearest neighbor matching without replacement, controlling for age, sex, race/ethnicity, obesity, socioeconomic risk factors, and tobacco use. Primary outcomes included pneumonia, bronchiectasis exacerbations, intensive care unit admission, mechanical ventilation, and mortality. Statistical analyses included risk ratios and Cox proportional hazards modeling for survival outcomes. Results Out of 421,710 patients with NCFB in the dataset from January 2000 to September 2025, 186,874 (44%) had a diagnosis of GERD. After propensity score matching, 179,753 patients with NCFB+GERD and 179,753 patients with NCFB-only were included (mean age 74.0±13.1 years, 58.8% female, 67.1% White). Baseline characteristics were well-balanced after matching. Median follow-up was approximately 2.5 years for both cohorts (898 vs 889 days; similar means and IQR), ensuring balanced observation time. Compared to NCFB-only, NCFB+GERD was associated with increased risks for mortality (risk ratio 1.04, 95% CI 1.02-1.05; p < 0.001), pneumonia (risk ratio 1.06, 95% CI 1.05-1.08; p < 0.001), bronchiectasis exacerbations (risk ratio 1.03, 95% CI 1.01-1.06; p = 0.006), and mechanical ventilation (risk ratio 1.14, 95% CI 1.10-1.18; p < 0.001). Intensive care unit admission rates were comparable between groups (risk ratio 1.00; p = 0.65). Conclusions In this large propensity score-matched analysis, concurrent GERD in NCFB is independently associated with increased mortality, pneumonia, bronchiectasis exacerbations, and mechanical ventilation requirements. These findings suggest GERD may represent a modifiable risk factor warranting aggressive management in NCFB patients. Study limitations include retrospective design, reliance on ICD-10 coding accuracy, and potential unmeasured confounders. Our results support systematic screening and treatment of GERD in NCFB, but whether targeted GERD management can modify the natural history of NCFB future investigation. This abstract is funded by: None