Bronchiolitis obliterans syndrome in heart-lung transplantation : Surveillance biopsies

Transbronchial biopsies (TBBs) are useful to diagnose acute rejection and infection in patients with lung transplants. The value of routine surveillance biopsies (S-TBBs) is not known, and such biopsies with a clinical indication are not without risk and are expensive. One hundred twenty-six 6-mo su...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 1997-05, Vol.155 (5), p.1705-1710
Main Authors: TAMM, M, SHARPLES, L. D, HIGENBOTTAM, T. W, STEWART, S, WALLWORK, J
Format: Article
Language:English
Subjects:
Actuarial Analysis
Adult
Biological and medical sciences
Biopsy, Needle - adverse effects
Bronchiolitis Obliterans - diagnosis
Bronchiolitis Obliterans - etiology
Female
Graft Rejection - diagnosis
Heart-Lung Transplantation - adverse effects
Heart-Lung Transplantation - mortality
Humans
Lung - pathology
Male
Medical sciences
Middle Aged
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the respiratory system
Survival Rate
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Summary:Transbronchial biopsies (TBBs) are useful to diagnose acute rejection and infection in patients with lung transplants. The value of routine surveillance biopsies (S-TBBs) is not known, and such biopsies with a clinical indication are not without risk and are expensive. One hundred twenty-six 6-mo survivors of heart-lung transplantation (HLT) were studied to determine the effect of stopping S-TBBs on the development of bronchiolitis obliterans syndrome (BOS) and subsequent survival. Fifty-one received transplants while S-TBB was part of routine care (group A), and 75 received transplants after this practice was stopped (group B). There was no difference in patient characteristics. Group A had shorter graft ischemia (p < 0.01) and longer postoperative ventilation (p < 0.01). Maintenance immunosuppression was similar, but group A had more steroid pulses in the second 6 mo after HLT (p < 0.01). The number of patients free from any functional deterioration at 49 to 60 mo after HLT declined to 39% in group A and 64% in group B. The risk of developing BOS grade 1 in group A relative to group B was 1.63 (95% confidence intervals: 0.96-2.79, p = 0.07). Patient survival was similar in the two groups. A total of 86 TBBs were taken in the absence of any signs or symptoms and had low diagnostic yield. In summary, there was no increased incidence of BOS after stopping S-TBBs.
ISSN:1073-449X
1535-4970
DOI:10.1164/ajrccm.155.5.9154880