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Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation.
J Heart Lung Transplant. 2009 Jan; 28(1):14-20.JH

Abstract

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.

Authors+Show Affiliations

Department of Lung Transplantation, University of Texas Medical Branch, Galveston, Texas, USA. vgvalent@utmb.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19134525

Citation

Valentine, Vincent G., et al. "Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 28, no. 1, 2009, pp. 14-20.
Valentine VG, Gupta MR, Weill D, et al. Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation. J Heart Lung Transplant. 2009;28(1):14-20.
Valentine, V. G., Gupta, M. R., Weill, D., Lombard, G. A., LaPlace, S. G., Seoane, L., Taylor, D. E., & Dhillon, G. S. (2009). Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 28(1), 14-20. https://doi.org/10.1016/j.healun.2008.10.010
Valentine VG, et al. Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation. J Heart Lung Transplant. 2009;28(1):14-20. PubMed PMID: 19134525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation. AU - Valentine,Vincent G, AU - Gupta,Meera R, AU - Weill,David, AU - Lombard,Gisele A, AU - LaPlace,Stephanie G, AU - Seoane,Leonardo, AU - Taylor,David E, AU - Dhillon,Gundeep S, Y1 - 2008/12/12/ PY - 2008/05/15/received PY - 2008/09/22/revised PY - 2008/10/16/accepted PY - 2009/1/13/entrez PY - 2009/1/13/pubmed PY - 2009/5/16/medline SP - 14 EP - 20 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 28 IS - 1 N2 - 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. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/19134525/Single_institution_study_evaluating_the_utility_of_surveillance_bronchoscopy_after_lung_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(08)00766-3 DB - PRIME DP - Unbound Medicine ER -