Prospective study of transbronchial biopsies in the management of heart-lung and single lung transplant patients.

Abstract

A prospective study of 219 bronchoscopies in 54 heart-lung and in 2 single lung transplant recipients was undertaken over a 12-month period by a single operator. For histologic study, an average of 17.3 transbronchial biopsy specimens (range, 6 to 56) were taken from three lobes (or from two lobes and lingula of one lung). A further two specimens were taken for culture. The average procedure time was 14.4 minutes (SE 0.31). An estimate of the probability of rejection being missed, depending on the number of specimens taken and based on the method of Gilman and Wang, suggests 18 biopsy specimens are required to have 95% confidence of diagnosing rejection. Sensitivity for diagnosing rejection by histologic study of transbronchial biopsy specimens was 94%, and specificity was 90%. The simple grading of severity of rejection that was used was related both to the number of specimens demonstrating rejection and to the severity of graft airway mucosal inflammation seen at bronchoscopy. The major complication encountered, on 27 occasions, was bleeding of more than 100 ml. On no occasion did bleeding result in any long-term complication. Extensive transbronchial biopsy is a simple, relatively safe, and quick procedure, with a high sensitivity and specificity for diagnosing rejection and lung infection.

Cite this paper

@article{Scott1991ProspectiveSO, title={Prospective study of transbronchial biopsies in the management of heart-lung and single lung transplant patients.}, author={John P. Scott and Guillaume Fradet and Rosalind L. Smyth and Paul A. Mullins and A. V. Pratt and Colin A Clelland and Timothy W Higenbottam and John Wallwork}, journal={The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation}, year={1991}, volume={10 5 Pt 1}, pages={626-36; discussion 636-7} }