Original article
General thoracic
Optimization of Transbronchial Cryobiopsy in Lung Transplant Recipients

https://doi.org/10.1016/j.athoracsur.2019.04.096Get rights and content

Background

Previous studies suggest that transbronchial lung biopsy using a cryoprobe is superior to transbronchial lung biopsy using forceps for evaluating lung grafts, although the technique can be associated an increase in complications. Because cryoprobe experience is limited, assessment of a greater number of cases is warranted. This prospective study evaluates the diagnostic yield, complications, and risk factors associated with the cryoprobe technique.

Methods

From April 2013 to April 2016, 321 consecutive cryoprobe transbronchial biopsies were indicated in single or bilateral lung transplant patients with acute or chronic clinical lung injury or in asymptomatic patients before hospital discharge after lung transplantation.

Results

With a mean of 4.32 lung parenchyma specimens per procedure, adequate alveolar lung parenchyma was obtained in 96.6% (84.27 ± 44.14 mm2) of cases. Obtaining at least 4 samples increased the histological diagnostic certainty (P < .001). Moderate to severe bleeding was observed in 7.48% of patients and was significantly more frequent in patients with unilateral transplantation (odds ratio, 0.10; 95% confidence interval, 0.02-0.30; P < .001) and in those with high blood pressure during scanning (odds ratio, 0.31; 95% confidence interval, 0.12-0.86; P = .019). Pneumothorax was observed in 7.7% of the patients, but only 3.7% of these patients required pleural drainage.

Conclusions

Obtaining 4 or more cryobiopsy samples is valuable and safe for lung allograft monitoring. Being a recipient of a unilateral lung transplant or having arterial hypertension during bronchoscopy seem to be risk factors associated with increased bleeding.

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,

References (28)

  • A.P. Khalifah et al.

    Minimal acute rejection after lung transplantation: a risk for bronchiolitis obliterans syndrome

    Am J Transplant

    (2005)
  • P.M. Hopkins et al.

    Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis

    Am J Respir Crit Care Med

    (2004)
  • J.P. Scott et al.

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

    J Heart Lung Transplant

    (1991)
  • J.A. Kropski et al.

    Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease

    PLoS One

    (2013)
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