SESSION TYPE: Pediatric Chest Disease
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Limited research exists on surveillance transbronchial biopsy (TBB) using flexible bronchoscopy and histologic analysis of allograft tissue acquired to assess for rejection in infants after lung or heart-lung transplantation.
METHODS: A retrospective review of children under one year of age after lung or heart-lung transplant at our institution was completed. Surveillance TBBs were performed as routine post-transplant care. Formalin-fixed, paraffin-embedded sections were stained with H&E (4 levels), trichrome, and elastic stains.
RESULTS: Since 2005, 4 infants (3 males, 1 female) were transplanted (3 heart-lung, 1 lung) for idiopathic pulmonary arterial hypertension, pulmonary vein stenosis, and surfactant deficiency (n=2). The mean age (± SD) at time of transplant was 5.5 ± 2.4 (range 3 to 8) months. A total of 16 surveillance TBB episodes were completed with a range of 2 to 8 per patient. A total of 5 tissue pieces were obtained in 81% of the TBB episodes and 3 pieces were obtained in 12% of the TBB episodes. All tissue pieces was evaluated for allograft rejection, including A-grade (acute cellular rejection) and B-grade (airway inflammation). A total of 94% (15/16) had A0 and 6% (1/16) had AX (no alveolated parenchyma), while B grade was identified as B0 in 50% (8/16), B1 in 12.5% (2/16), and BX (no airway epithelium present) in 37.5% (6/16) of patients. There was a significantly higher adequacy of tissue sampling for A-grade versus B-grade (p value = 0.0377). Moreover, C-grade (chronic airway rejection or obliterative bronchiolitis) rejection and D-grade (chronic vascular rejection) rejection were not identified.
CONCLUSIONS: Surveillance TBBs in infant lung and heart-lung transplant recipients were safely performed and readily identified A-grade rejection but not B-grade rejection when three to five tissue pieces were obtained, while C-grade or D-grade rejection was not identified.
CLINICAL IMPLICATIONS: Surveillance TBB in infant lung and heart-lung transplant recipients provided sufficient tissue to detect A-grade rejection, but the acquisition of airway epithelium by other means should be considered for B-grade rejection, such as endobronchial biopsy.
DISCLOSURE: The following authors have nothing to disclose: Don Hayes, Jr., Peter Baker, Benjamin Kopp, Stephen Kirkby, Mark Galantowicz, Todd Astor
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