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Transplantation |

Retrospective Review of 289 Transbronchial Biopsies in 125 Lung Recipients

Ping Shi Zhu; Thomas Vandemoortele; Anna Yiannopoulos; Pasquale Ferraro; Charles D. Poirier
Author and Funding Information

Department of Respirology, CHUM (Centre Hospitalier de l'Université de Montréal) Hôpital Notre-Dame, Montreal, QC, Canada


Chest. 2014;146(4_MeetingAbstracts):982A. doi:10.1378/chest.1975017
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Abstract

SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Transbronchial biopsy (TBB) plays a key role in the evaluation of allograft rejection after lung transplant. The aim of this study was to describe the indications, efficacy and complications of TBB in lung recipients.

METHODS: We retrospectively reviewed the data of 289 TBB performed in 125 patients between October 2010 and December 2013 at a single tertiary institution. Different clinical and pathological parameters were analyzed in order to determine factors influencing TBB yield and complications. Performance of TBB was assessed in terms of providing adequate parenchymal specimens and establishing a diagnosis.

RESULTS: Mean age of the 125 patients was 44 years old (range 18-67), with 64 (51.2%) males. Of the 289 TBB, 230 (79.6%) were surveillance procedures, 37 were clinically indicated (as dictated by respiratory tract symptoms or decline in lung function parameters), whereas 22 were for monitoring after acute rejection. The mean number of biopsy samples was 5.14 (±1.22). In 271 cases (93.8%), TBB was considered to have a diagnostic value as it provided adequate alveolated tissue specimens. Acute rejection was detected in 22 cases (7.6% of adequate TBB). Among the 22 cases of acute rejection, there were 17 (77.3%) grade A1, 4 (18.2%) grade A2 and 1(4.5%) grade B1. The yield of an adequate specimen was optimized with 3 to 4 biopsies (p=0.015), while no advantage was seen with ≥ 5 biopsies (p=0.196). TBB was associated with at least 1 complication in 53 cases (19%). Bleeding (≥ 30 cc or at least moderate as estimated by the bronchoscopist) was the main complication, which occurred in 37 cases (12.8%). All were controlled with cold saline and/or local adrenaline. Pneumothorax was seen in 8 cases (2.8%); only one required a chest drain. All 8 pneumothoraces were related to a number of biopsies ≥ 5. Desaturation was seen in 19 cases (6.6%); all were corrected with supplemental oxygen. Only 1 patient (0.3%) developed a pneumonia within 10 days of the procedure. The risk of complication increased with the patient’s age (p=0.041).

CONCLUSIONS: TBB with 3 or 4 biopsies has an interesting diagnostic value in lung recipients. It appears to be a passably safe procedure, with only rare major complications seen in our cohort.

CLINICAL IMPLICATIONS: TBB is an important part of post-lung transplant follow-up. According to our data, 3 to 4 biopsies are enough to provide adequate tissue while minimizing complications.

DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Thomas Vandemoortele, Anna Yiannopoulos, Pasquale Ferraro, Charles D. Poirier

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