Patients undergoing liver transplantation are at an increased risk of developing pulmonary fections. Immunosuppression leads to increased susceptibility to bacterial as well as opportunistic pathogens. A common method to aid in the diagnosis of respiratory infections is bronchoscopy. The purpose of this study is to evaluate the clinical efficacy of bronchoscopy for the diagnosis of pulmonary infections following liver transplantation.
A retrospective chart review of hospitalized liver transplant patients who underwent bronchoscopy from January 1997 through March 2002. Inclusion criteria included adult patients, who had a bronchoscopy preformed after liver transplantation. Indications for bronchoscopy included fever, radiographic changes on chest imaging, or respiratory decline. Data collected included indication for bronchoscopy, ventilator status, antibiotics prior to bronchoscopy, antibiotic changes after bronchoscopy, and culture results from BAL.
Over the 5 year period, 1260 bronchoscopies were performed. In the 48 patients a total of 74 bronchoscopies were preformed. Five patients and 9 bronchoscopies were not included do to lack of data or did not meet the inclusion criteria. Twenty-eight patients had a single bronchoscopy and 15 patients had multiple bronchoscopies (2-4). A organism was found in 36 out of the 43 (83%) patients and in 49 out of the 65 (75%) of the bronchoscopies. The most common organism found was viral (52%) followed by fungal (28%) and bacterial (19%). Of the viral pathogens, CMV was the most common (26 out of 41). Based on the bronchoscopy results antimicrobial therapy was altered in 55% of the cases with the additional of an antiviral being the most common change.CONCLUSIONS: In our study, an organism was isolated in a greater proportion of BAL samples as compared to previously reported studies. Of the organisms isolated, CMV remains a significant pathogen in the liver transplant patients. Bronchoscopy had a positive impact on antimicrobialselection.CLINICAL IMPLICATIONS: In liver transplant patients, bronchoscopy is an important diagnostic tool, useful for directing antimicrobial therapy.
J.L. Spencer, None.