Transplantation |

The High Yield of Transbronchial Cryobiopsy in Lung Transplantation Patients FREE TO VIEW

Oren Fruchter*, MD; Ludmila Fridel, MD; Mordechai Kramer, MD
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Rabin Medical Center, Petah Tikva, Israel

Chest. 2012;142(4_MeetingAbstracts):1094A. doi:10.1378/chest.1388990
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SESSION TYPE: Lung Transplantation Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Transbronchial biopsies obtained by forceps via fiberoptic bronchoscopy remains the gold standard to establish the presence of acute allograft rejection or infection after lung transplantation. In patients with interstitial lung diseases, transbronchial lung biopsies obtained by flexible cryo-probe, exceeded the size and quality of forceps biopsy samples. Our aim was to evaluate the diagnostic yield and complication rates of cryobiopsy in lung transplantation patients.

METHODS: Thirty-five lung transplantation patients (mean age 58.7 years) were studied. Patients underwent routine surveillance bronchoscopy (n=15), or clinically indicated bronchoscopy to diagnose rejection or infection due to clinical worsening (n=10) . Cryobiopsy was obtained by a flexible cryo-probe under fluoroscopy, only 1-2 samples were taken. Procedure charecteristics , the diagnostic yield and the complication rate were compared with historical controls consisted of 35 lung transplantation patients matched by age, time from transplantation, and indication for bronchoscopy, in whom 6-8 bronchoscopic lung biopsies were obtained by forceps.

RESULTS: No significant bleeding or pneumothorax occurred following transbronchial cryo-biopsy. The mean duration of bronchoscopy using cryo-probe was significantly shorter than the traditional forceps biopsy technique (5 versus 8 minutes, respectively). The mean diameter of the specimen taken by forceps in historical controls was 2 mm compared to 10 mm obtained using the cryoprobe, and no crush artifacts were observed. The increased size and quality of biopsy samples in the study group translated to a significant increase in the percentage of alveolated tissue ( versus, respectively) that enables a clear histological detection of acute rejection (n= 4) pneumonitis (n= 2) , diffuse alveolar damage (n= 1) , and confident exclusion of acute rejection , infection or pneumonitis (n= 28).

CONCLUSIONS: Cryo-transbronchial biopsy for both surveillance and clinically indicated bronchoscopy in lung transplantation patients provides larger and more diagnostic lung parenchyma specimens with low complication rate and shorter intervention time than forceps biopsy.

CLINICAL IMPLICATIONS: Cryo-transbronchial biopsy may become the preferred method for lung biopsy in lung transplantation patients

DISCLOSURE: The following authors have nothing to disclose: Oren Fruchter, Ludmila Fridel, Mordechai Kramer

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Rabin Medical Center, Petah Tikva, Israel




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