Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation

Vincent G. Valentine, Meera R. Gupta, David Weill, Gisele A. Lombard, Stephanie G. LaPlace, Leonardo Seoane, David E. Taylor, Gundeep S. Dhillon

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Many lung transplant physicians advocate surveillance bronchoscopy with transbronchial lung biopsy and bronchoalveolar lavage (TBB/BAL) to monitor lung recipients despite limited evidence this strategy improves outcomes. This report compares rates of infection (INF), acute rejection (AR), bronchiolitis obliterans syndrome (BOS) and survival in lung allograft recipients managed with surveillance TBB/BAL (SB) versus those with clinically indicated TBB/BAL (CIB). Methods: We reviewed 47 consecutive recipients transplanted between March 2002 and August 2005. Of these recipients, 24 consented to a multi-center trial requiring SB and 23 were managed by our usual practice of CIB. Rates of freedom from INF, AR, BOS and survival were compared. BOS and AR were diagnosed according to published guidelines from the International Society for Heart and Lung Transplantation. Results: A total of 240 TBB/BALs were performed. CIB and SB groups underwent 84 (3.7 ± 3.4/patient) and 156 (6.5 ± 2.0/patient) TBB/BALs, respectively. In the SB group, 54 (2.2 ± 1.6/patient) TBB/BALs were true surveillance procedures, whereas 102 (4.2 ± 2.3/patient) were clinically indicated. No AR episode requiring treatment was detected by true surveillance. Freedom from respiratory INF, AR, BOS and survival in the SB and CIB groups showed no significant differences. Five patients in the CIB group remained stable without requiring TBB/BAL. In the SB group, 4 previously asymptomatic patients developed pneumonia within 2 weeks of surveillance TBB/BAL. Conclusions: With no obvious advantage identified, surveillance bronchoscopy may pose a risk to stable lung transplant recipients. A multi-center, controlled trial is required to validate the utility and safety of surveillance bronchoscopy in lung transplantation.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume28
Issue number1
DOIs
StatePublished - Jan 2009

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Dimercaprol
Lung Transplantation
Bronchoscopy
Bronchoalveolar Lavage
Bronchiolitis Obliterans
Biopsy
Lung
Survival
Infection
Respiratory Tract Infections
Allografts
Pneumonia

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Valentine, V. G., Gupta, M. R., Weill, D., Lombard, G. A., LaPlace, S. G., Seoane, L., ... Dhillon, G. S. (2009). Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation. Journal of Heart and Lung Transplantation, 28(1), 14-20. https://doi.org/10.1016/j.healun.2008.10.010

Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation. / Valentine, Vincent G.; Gupta, Meera R.; Weill, David; Lombard, Gisele A.; LaPlace, Stephanie G.; Seoane, Leonardo; Taylor, David E.; Dhillon, Gundeep S.

In: Journal of Heart and Lung Transplantation, Vol. 28, No. 1, 01.2009, p. 14-20.

Research output: Contribution to journalArticle

Valentine, VG, Gupta, MR, Weill, D, Lombard, GA, LaPlace, SG, Seoane, L, Taylor, DE & Dhillon, GS 2009, 'Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation', Journal of Heart and Lung Transplantation, vol. 28, no. 1, pp. 14-20. https://doi.org/10.1016/j.healun.2008.10.010
Valentine, Vincent G. ; Gupta, Meera R. ; Weill, David ; Lombard, Gisele A. ; LaPlace, Stephanie G. ; Seoane, Leonardo ; Taylor, David E. ; Dhillon, Gundeep S. / Single-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation. In: Journal of Heart and Lung Transplantation. 2009 ; Vol. 28, No. 1. pp. 14-20.
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abstract = "Background: Many lung transplant physicians advocate surveillance bronchoscopy with transbronchial lung biopsy and bronchoalveolar lavage (TBB/BAL) to monitor lung recipients despite limited evidence this strategy improves outcomes. This report compares rates of infection (INF), acute rejection (AR), bronchiolitis obliterans syndrome (BOS) and survival in lung allograft recipients managed with surveillance TBB/BAL (SB) versus those with clinically indicated TBB/BAL (CIB). Methods: We reviewed 47 consecutive recipients transplanted between March 2002 and August 2005. Of these recipients, 24 consented to a multi-center trial requiring SB and 23 were managed by our usual practice of CIB. Rates of freedom from INF, AR, BOS and survival were compared. BOS and AR were diagnosed according to published guidelines from the International Society for Heart and Lung Transplantation. Results: A total of 240 TBB/BALs were performed. CIB and SB groups underwent 84 (3.7 ± 3.4/patient) and 156 (6.5 ± 2.0/patient) TBB/BALs, respectively. In the SB group, 54 (2.2 ± 1.6/patient) TBB/BALs were true surveillance procedures, whereas 102 (4.2 ± 2.3/patient) were clinically indicated. No AR episode requiring treatment was detected by true surveillance. Freedom from respiratory INF, AR, BOS and survival in the SB and CIB groups showed no significant differences. Five patients in the CIB group remained stable without requiring TBB/BAL. In the SB group, 4 previously asymptomatic patients developed pneumonia within 2 weeks of surveillance TBB/BAL. Conclusions: With no obvious advantage identified, surveillance bronchoscopy may pose a risk to stable lung transplant recipients. A multi-center, controlled trial is required to validate the utility and safety of surveillance bronchoscopy in lung transplantation.",
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AU - Seoane, Leonardo

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AB - Background: Many lung transplant physicians advocate surveillance bronchoscopy with transbronchial lung biopsy and bronchoalveolar lavage (TBB/BAL) to monitor lung recipients despite limited evidence this strategy improves outcomes. This report compares rates of infection (INF), acute rejection (AR), bronchiolitis obliterans syndrome (BOS) and survival in lung allograft recipients managed with surveillance TBB/BAL (SB) versus those with clinically indicated TBB/BAL (CIB). Methods: We reviewed 47 consecutive recipients transplanted between March 2002 and August 2005. Of these recipients, 24 consented to a multi-center trial requiring SB and 23 were managed by our usual practice of CIB. Rates of freedom from INF, AR, BOS and survival were compared. BOS and AR were diagnosed according to published guidelines from the International Society for Heart and Lung Transplantation. Results: A total of 240 TBB/BALs were performed. CIB and SB groups underwent 84 (3.7 ± 3.4/patient) and 156 (6.5 ± 2.0/patient) TBB/BALs, respectively. In the SB group, 54 (2.2 ± 1.6/patient) TBB/BALs were true surveillance procedures, whereas 102 (4.2 ± 2.3/patient) were clinically indicated. No AR episode requiring treatment was detected by true surveillance. Freedom from respiratory INF, AR, BOS and survival in the SB and CIB groups showed no significant differences. Five patients in the CIB group remained stable without requiring TBB/BAL. In the SB group, 4 previously asymptomatic patients developed pneumonia within 2 weeks of surveillance TBB/BAL. Conclusions: With no obvious advantage identified, surveillance bronchoscopy may pose a risk to stable lung transplant recipients. A multi-center, controlled trial is required to validate the utility and safety of surveillance bronchoscopy in lung transplantation.

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