Original articleGeneral thoracicOptimization of Transbronchial Cryobiopsy in Lung Transplant Recipients
Section snippets
Patients and Methods
This study was prospective, observational, longitudinal, and non-randomized. The primary goal of the study was to assess the diagnostic yield of CB. The secondary endpoints of the study were to assess safety and the quality of the samples obtained, as well as identify complications and risk factors according to the type of transplant.
Consecutive CBs indicated in single or bilateral lung transplant patients with acute or chronic clinical lung injury or in asymptomatic patients before hospital
Results
A total of 1387 specimens from 321 (average 4.2; range, 1-6) consecutive CBs were obtained from 206 different patients with either double (n = 116, 56.3%) or single LT. More than 1 biopsy was collected from 115 patients: 2, 3, 4, 5, and 6 biopsies were collected from 76, 25, 9, 4, and 1 patient(s), respectively.
All demographic, clinical, and pathologic parameters are presented in Tables 1 and 2. Both LT types were comparable, although PH and AH prior to LT were more frequent in the patients
Comment
To our knowledge, this study includes the largest number of bronchoscopic procedures and CB specimens in patients with LT. In this study, with an average of 4.32 specimens per procedure, adequate alveolar parenchyma was retrieved in 96.6% of CBs. Obtaining 4 or more samples results in a significant increase in diagnostic certainty without an increase in complications. Anja and coworkers19 claim that obtaining 3 CBs with alveolar parenchyma may be sufficient to assess lung graft rejection,
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Cited by (15)
Interventional pulmonology techniques in lung transplantation
2023, Respiratory MedicineLung allograft standardized histological analysis (LASHA) template: A research consensus proposal
2022, Journal of Heart and Lung TransplantationCitation Excerpt :The most commonly encountered biopsy is the fiberoptic transbronchial biopsy (TBB) and the template has been designed accordingly. However, other diagnostic techniques such as the transbronchial cryobiopsy can be accommodated.15-18 Surgical biopsies are infrequently performed and generally attempted when other investigations fail to yield the diagnosis.
Cryobiopsy as a New Tool for Complications Diagnosis During Follow-up After Lung Transplantation: Single Institution Case Series
2021, Transplantation ProceedingsCitation Excerpt :TBCB is safe for lung allograft monitoring. Loor et al [6] shows that obtaining 4 or more cryobiopsy samples is valuable and safe for lung allograft monitoring. They observed moderate to severe bleeding in unilateral LTx during transbronchial lung biopsy using a cryoprobe compared with bilateral transplantations.
Transbronchial Cryobiopsies in Lung Allograft Recipients for Surveillance Purposes: Initial Results
2020, Transplantation ProceedingsCitation Excerpt :In 2019 Loor et al reported 7.5% of moderate to severe bleeding after TCB procedures, significantly more frequent in patients with unilateral transplantation and in those with high blood pressure during bronchoscopy. Twenty-five (7.7%) cases developed pneumothorax after TCB, of which 12 (3.7%) required chest tube placement [9]. In this study, the overall complication rate in scheduled TCB was 9%: 1 pneumothorax case required chest tube drainage and 6 moderate bleedings.
New opacities in lung allograft after transbronchial cryobiopsy
2020, Respiratory MedicineCitation Excerpt :Written informed consent for participation in the study with data protection was obtained before bronchoscopy. Sedation, monitoring, and cryobiopsy were performed as previously described [15,20]. After obtaining each specimen, the airway was reviewed with a second bronchoscope to assess the appearance of possible complications, and an endobronchial blocker (Model B5−2C®, Olympus Medical System Corp, Tokyo, Japan) was always available.