Prospective analysis of 1,235 transbronchial lung biopsies in lung transplant recipients

Fiber-optic bronchoscopy with multiple transbronchial lung biopsies (TBB) is the gold standard of evaluation of the pulmonary allograft post–lung transplantation (LT). However, controversy exists regarding the need for surveillance procedures and number of biopsy specimens required for satisfactory...

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Veröffentlicht in:The Journal of heart and lung transplantation 2002-10, Vol.21 (10), p.1062-1067
Hauptverfasser: Hopkins, Peter M, Aboyoun, Christina L, Chhajed, Prashant N, Malouf, Monique A, Plit, Marshall L, Rainer, Stephen P, Glanville, Allan R
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container_end_page 1067
container_issue 10
container_start_page 1062
container_title The Journal of heart and lung transplantation
container_volume 21
creator Hopkins, Peter M
Aboyoun, Christina L
Chhajed, Prashant N
Malouf, Monique A
Plit, Marshall L
Rainer, Stephen P
Glanville, Allan R
description Fiber-optic bronchoscopy with multiple transbronchial lung biopsies (TBB) is the gold standard of evaluation of the pulmonary allograft post–lung transplantation (LT). However, controversy exists regarding the need for surveillance procedures and number of biopsy specimens required for satisfactory yield. The potential morbidity in obtaining multiple TBB specimens remains poorly described. We report the largest series of TBB in LT recipients to date, highlighting the occurrence of acute rejection and infection for surveillance and diagnostic procedures. The safety of TBB is analyzed and a biopsy schedule proposed. Prospective analysis of 1,235 TBB in 230 LT recipients performed at St Vincent’s Hospital from January 1995 to June 2000. Eight hundred thirty-six (67.7%) TBB were performed as surveillance and 399 (32.3%) for a clinical indication. No significant acute rejection (AR) or infection was disclosed in 53.3% of procedures. The Lung Rejection Study Group requirement of at least five pieces of evaluable lung parenchyma was achieved in 98.2% of procedures. The average number of evaluable fragments per procedure was 6.4, whereas only 3 TBB (0.24%) contained no lung parenchyma and 44 (3.6%) no bronchial wall. Histologic features of AR, lymphocytic bronchiolitis or infection were found in 18.9% of surveillance and 86.4% of clinical TBBs. The yield of surveillance procedures between 4 and 12 months was just 1.1% for cytomegalovirus and 6.1% for AR. The overall complication rate was 6.35% with no deaths recorded. Taking 10 to 12 TBB specimens has a high diagnostic yield and rarely fails to provide adequate tissue. The role of surveillance procedures post–lung transplantation remains controversial.
doi_str_mv 10.1016/S1053-2498(02)00442-4
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However, controversy exists regarding the need for surveillance procedures and number of biopsy specimens required for satisfactory yield. The potential morbidity in obtaining multiple TBB specimens remains poorly described. We report the largest series of TBB in LT recipients to date, highlighting the occurrence of acute rejection and infection for surveillance and diagnostic procedures. The safety of TBB is analyzed and a biopsy schedule proposed. Prospective analysis of 1,235 TBB in 230 LT recipients performed at St Vincent’s Hospital from January 1995 to June 2000. Eight hundred thirty-six (67.7%) TBB were performed as surveillance and 399 (32.3%) for a clinical indication. No significant acute rejection (AR) or infection was disclosed in 53.3% of procedures. The Lung Rejection Study Group requirement of at least five pieces of evaluable lung parenchyma was achieved in 98.2% of procedures. The average number of evaluable fragments per procedure was 6.4, whereas only 3 TBB (0.24%) contained no lung parenchyma and 44 (3.6%) no bronchial wall. Histologic features of AR, lymphocytic bronchiolitis or infection were found in 18.9% of surveillance and 86.4% of clinical TBBs. The yield of surveillance procedures between 4 and 12 months was just 1.1% for cytomegalovirus and 6.1% for AR. The overall complication rate was 6.35% with no deaths recorded. Taking 10 to 12 TBB specimens has a high diagnostic yield and rarely fails to provide adequate tissue. 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Graft diseases</topic><topic>Surgery of the respiratory system</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hopkins, Peter M</creatorcontrib><creatorcontrib>Aboyoun, Christina L</creatorcontrib><creatorcontrib>Chhajed, Prashant N</creatorcontrib><creatorcontrib>Malouf, Monique A</creatorcontrib><creatorcontrib>Plit, Marshall L</creatorcontrib><creatorcontrib>Rainer, Stephen P</creatorcontrib><creatorcontrib>Glanville, Allan R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hopkins, Peter M</au><au>Aboyoun, Christina L</au><au>Chhajed, Prashant N</au><au>Malouf, Monique A</au><au>Plit, Marshall L</au><au>Rainer, Stephen P</au><au>Glanville, Allan R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective analysis of 1,235 transbronchial lung biopsies in lung transplant recipients</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2002-10-01</date><risdate>2002</risdate><volume>21</volume><issue>10</issue><spage>1062</spage><epage>1067</epage><pages>1062-1067</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Fiber-optic bronchoscopy with multiple transbronchial lung biopsies (TBB) is the gold standard of evaluation of the pulmonary allograft post–lung transplantation (LT). 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subjects Adolescent
Adult
Biological and medical sciences
Biopsy - methods
Bronchi - pathology
Bronchoscopy
Child
Female
Graft Rejection - pathology
Humans
Lung Transplantation
Male
Medical sciences
Middle Aged
Postoperative Period
Prospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the respiratory system
Transplantation, Homologous
title Prospective analysis of 1,235 transbronchial lung biopsies in lung transplant recipients
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