Clinical lung and heart/lung transplantationSingle-institution Study Evaluating the Utility of Surveillance Bronchoscopy After Lung Transplantation
Section snippets
Methods
Between March 2002 and August 2005, 47 consecutive patients underwent lung transplantation. Analysis of AR, INF, BOS and survival data was completed through April 2007. The surveillance TBB/BAL group included 24 patients who consented to surveillance monitoring as part of a separate multi-center trial. This multi-center trial excluded cytomegalovirus (CMV)-negative recipients of CMV-positive donors. Therefore, during transplant evaluation only CMV-positive patients were considered for inclusion
Results
Other than induction immunosuppression and CMV serostatus, baseline and post-operative characteristics across groups were similar, as shown in Table 1, Table 2. In the SB cohort, 96 TBB/BALs were expected; however, 1 patient died on POD 12, and 3 others died before the first year post-operatively. Therefore, 89 TBB/BALs were scheduled with 38 clinical indications: 34% by exam (worsening dyspnea or cough, fever, tachycardia or new auscultatory findings), 32% by FEF25–75% criteria, 21% by FEV1
Discussion
This is the first prospective study evaluating the role of regularly scheduled TBB/BAL in asymptomatic lung transplant recipients. No statistical differences in AR, INF or BOS-free survival and patient survival were seen (Figure 1, Figure 2). Moreover, as no AR episodes requiring treatment were detected by true surveillance TBB/BAL, the incremental value of scheduled procedures in asymptomatic recipients with stable PFTs and chest radiographs is minimal. The SB cohort required 50% more TBB/BAL
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The role of surveillance bronchoscopy after lung transplantation
2024, Revue des Maladies RespiratoiresDonor-derived cell-free DNA as a composite marker of acute lung allograft dysfunction in clinical care
2022, Journal of Heart and Lung TransplantationCitation Excerpt :Proponents further argue that the early detection and treatment of allograft injury may improve outcomes, namely a reduction in the development of CLAD – which has the greatest impact on long term survival in lung transplant recipients. In contrast, opponents argue that routine surveillance bronchoscopy is costly, time consuming, places the patient at risk of complications and has not been demonstrated to improve outcomes.38,39 In addition, the utility of performing surveillance bronchoscopy may decrease considerably after 3 months as the presence of asymptomatic rejection or infection decreases.40,41
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2020, Journal of Heart and Lung TransplantationSurveillance Bronchoscopy in Lung Transplantation Recipients: A Single Center Experience Analysis
2020, Transplantation ProceedingsCitation Excerpt :In 2002, Valentine et al compared 91 LTx recipients in the Ochsner Clinic with 5430 patients on the historical controls published by the ISHLT and found no difference in 1- to 3-year mortality and ACR when bronchoscopy was performed only when clinically indicated: asymptomatic 10% decline in FEV1 from established baseline; asymptomatic 20% decline in intermediary force expiratory flow (FEF25%-75%) from established baseline; unexplained dyspnea, nonproductive cough, or fever; or new auscultatory findings on lung exam [10]. A further report from Valentine et al in 2009 compared rates of ACR, infection, BOS, and survival in LTx recipients managed with SB vs those with clinically indicated bronchoscopy (CIB) [11]. Clinical indications included unexplained respiratory symptoms, signs, or fever; 10% decline in FEV1 or 20% decrease in forced expiratory flow (FEF25%-75%) below baseline; delay in anticipated improvement in lung function, especially if the forced vital capacity and FEV1 remained 60% predicted with FEF25%-75% remaining 50% of predicted; or radiographic changes.