Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation

Autor: Leonardo Seoane, Gisele A. Lombard, Vincent G. Valentine, Meera Gupta, David Weill, D.E. Taylor, S.G. LaPlace, Gundeep Dhillon
Rok vydání: 2009
Předmět:
Adult
Graft Rejection
Lung Diseases
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Bronchiolitis obliterans
Infections
Bronchoalveolar Lavage
Asymptomatic
Young Adult
Postoperative Complications
Bronchoscopy
Internal medicine
medicine
Humans
Multicenter Studies as Topic
Transplantation
Homologous
Lung transplantation
Postoperative Period
Bronchiolitis Obliterans
Aged
Monitoring
Physiologic
Retrospective Studies
Transplantation
Lung
medicine.diagnostic_test
business.industry
Length of Stay
Middle Aged
respiratory system
medicine.disease
Survival Analysis
respiratory tract diseases
Surgery
Pneumonia
Bronchoalveolar lavage
medicine.anatomical_structure
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Lung Transplantation
Zdroj: The Journal of Heart and Lung Transplantation. 28:14-20
ISSN: 1053-2498
DOI: 10.1016/j.healun.2008.10.010
Popis: Background Many lung transplant physicians advocate surveillance bronchoscopy with transbronchial lung biopsy and bronchoalveolar lavage (TBB/BAL) to monitor lung recipients despite limited evidence this strategy improves outcomes. This report compares rates of infection (INF), acute rejection (AR), bronchiolitis obliterans syndrome (BOS) and survival in lung allograft recipients managed with surveillance TBB/BAL (SB) versus those with clinically indicated TBB/BAL (CIB). Methods We reviewed 47 consecutive recipients transplanted between March 2002 and August 2005. Of these recipients, 24 consented to a multi-center trial requiring SB and 23 were managed by our usual practice of CIB. Rates of freedom from INF, AR, BOS and survival were compared. BOS and AR were diagnosed according to published guidelines from the International Society for Heart and Lung Transplantation. Results A total of 240 TBB/BALs were performed. CIB and SB groups underwent 84 (3.7 ± 3.4/patient) and 156 (6.5 ± 2.0/patient) TBB/BALs, respectively. In the SB group, 54 (2.2 ± 1.6/patient) TBB/BALs were true surveillance procedures, whereas 102 (4.2 ± 2.3/patient) were clinically indicated. No AR episode requiring treatment was detected by true surveillance. Freedom from respiratory INF, AR, BOS and survival in the SB and CIB groups showed no significant differences. Five patients in the CIB group remained stable without requiring TBB/BAL. In the SB group, 4 previously asymptomatic patients developed pneumonia within 2 weeks of surveillance TBB/BAL. Conclusions With no obvious advantage identified, surveillance bronchoscopy may pose a risk to stable lung transplant recipients. A multi-center, controlled trial is required to validate the utility and safety of surveillance bronchoscopy in lung transplantation.
Databáze: OpenAIRE
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