PURPOSE: Surveillance Fiberoptic bronchoscopies are routinely performed in recipients of lung transplants to identify asymptomatic rejection or infection. Transbronchial biopsies have been shown to find occult rejection; however, there is no evidence that surveillance BAL is useful to identify asymptomatic infections. We reviewed our institution's data to determine the utility of routine studies for Pneumocystis Carinii Pneumonia (PCP), Legionella, Cytomegalovirus (CMV) and Acid-Fast Bacilli (AFB).
METHODS: We performed a retrospective chart review of surveillance bronchoscopies from 03/2005 to 11/2007 at Henry Ford Hospital. We identified results of direct fluorescent Ab (DFU-Ab) for PCP Ag, DFU-Ab for Legionella Ag, Viral Cultures for CMV and AFB smear and cultures.
RESULTS: We identified 95 surveillance bronchoscopies performed on 22 asymptomatic lung transplant recipients during this period. PCP, Legionella, and CMV were negative in all 95 procedures. One BAL was positive for AFB but the cultures identified it as Mycobacterium Chelonae. This organism is most likely a laboratory contaminant and did not require treatment.
CONCLUSION: Our data shows that the diagnostic yield of surveillance BAL for infection in asymptomatic lung transplant recipients is extremely low. It had no impact on the treatment and outcomes in these patients. The cost of these four tests added approximately $600 per bronchoscopy.
CLINICAL IMPLICATIONS: Our results suggest that PCP Ag, Legionella Ag, Viral Cultures and AFB smear and culture are not necessary tests are for surveillance bronchoscopy. They pose an unnecessary labor and cost burden on the microbiology laboratory but rarely ever identify an underlying infectious pathology.
DISCLOSURE: Sankalp Choudhri, No Financial Disclosure Information; No Product/Research Disclosure Information