Diagnostic yield and therapeutic impact of flexible bronchoscopy in lung transplant recipients

Chan, Choong-Chee; Abi-Saleh, Wajdy J.; Arroliga, Alejandro C.; Stillwell, Paul C.; Kirby, Thomas J.; Gordon, Steven M.; Petras, Robert E.; Mehta, Atul C.

doi:10.1097/00128594-199701000-00028

Cited by 29 publications

(38 citation statements)

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“…To differentiate colonisation from infection, protected brush catheter cultures (regarded as the 'gold standard'), quantitative BAL and sputum cultures are being used, although not consistently in identical settings, making comparisons between studies difficult [2][3][4][5][28][29][30][31][32][33]. Regular BAL, which has a high diagnostic accuracy for the detection of lower airway inflammation, is also a generally accepted tool to assess airway inflammation [28][29][30][31][32][33]. Hence, in the present study, colonisation was defined as isolation of Pseudomonads from at least two consecutive BAL or sputum cultures, as determined by the aforementioned criteria.…”

Section: Discussionmentioning

confidence: 99%

Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?

Vos¹,

Vanaudenaerde²,

Geudens³

et al. 2008

Eur Respir J

161

134

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Airway colonisation with Pseudomonads, especially Pseudomonas aeruginosa, is common in lung transplant (LTx) recipients. The current authors investigated whether pseudomonal colonisation affects the prevalence of bronchiolitis obliterans syndrome (BOS) after lung transplantation.In the present retrospective study, 92 double (SS)LTx recipients (26 cystic fibrosis (CF) and 66 non-CF patients), with at least two consecutive post-operative bronchoalveolar lavage or sputum cultures evaluated for Pseudomonads, were included. Freedom of BOS was investigated in postoperatively colonised and noncolonised patients.The current study has shown post-operative airway colonisation to be an independent risk factor for BOS stage o1 and to be associated with a worse BOS stage o1-free survival in univariate analysis, especially in CF SSLTx recipients. Multivariate analysis demonstrated a trend for colonisation only as an independent risk factor for BOS; however, this pointed to a possible role in the development of BOS.In conclusion, pseudomonal airway colonisation after lung transplantation may be associated with an increased prevalence of bronchiolitis obliterans syndrome, especially in cystic fibrosis patients. Possible pathophysiological mechanisms in the development of bronchiolitis obliterans syndrome need further investigation, although the induction of neutrophilic airway inflammation seems to be its main characteristic.

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Section: Discussionmentioning

confidence: 99%

Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?

Vos¹,

Vanaudenaerde²,

Geudens³

et al. 2008

Eur Respir J

161

134

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“…In solid-organ transplant recipients, FOB has a diagnostic yield that varies between 27% and 85%, 18,21,[26][27][28][29][30][31][32] and the addition of TBB tends to increase the diagnostic yield compared with BAL alone. In a retrospective study of 104 immunosuppressed patients of whom 14.4% were solid-organ transplant recipients, 26 the combination of TBB and BAL increased the diagnostic yield to 70% when compared with BAL alone 38%.…”

Section: Diagnostic Yield and Impact Of The Results Of Fiber-optic Brmentioning

confidence: 99%

“…Changes in medical management have been reported between 20% and 70% after bronchoscopy. 21 Wallace and Kolbe 22 reported a change in therapy based on the BAL results in 61% of patients and showed that if only empirical management strategy was followed, 28% of the patients would have received incorrect treatment.…”

Section: Fiber-optic Bronchoscopy In Solid-organ Transplant Recipientsmentioning

confidence: 99%

“…The main complications of FOB were bleeding (13.5%; 95% confidence interval [CI], [8][9][10][11][12][13][14][15][16][17][18][19][20][21], pneumothorax requiring drainage 0% to 16%, 36,37 hypotension and hypoxia with oxygen saturation less than 90% (9.6%; 95% CI, 6%-17%). There was no correlation between the presence of complications and the level of positive end-expiratory pressure, peak and plateau pressures, and number of TBB with the presence of pneumothorax.…”

Section: Safety Of Fiber-optic Bronchoscopy On Mechanically Ventilatementioning

confidence: 99%

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Invasive Diagnostic Strategies in Immunosuppressed Patients with Acute Respiratory Distress Syndrome

Sánchez¹,

Ghamande²,

Midturi³

et al. 2014

Clinics in Chest Medicine

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“…The yield for acute rejection by transbronchial biopies was reported as 6.1-31% and 25% or greater in studies performing surveillance biopsies, clinically indicated and follow-up bronchoscopies [24,25]. Grade A2 and higher acute rejection have been found in a relatively high percentage of asymptomatic patients, ranging from 22-39% [26].…”

Section: Transbronchial Biopsymentioning

confidence: 99%

The Pathology of Lung Allograft Rejection: A Concise Review

Roden¹,

Tazelaar²

2012

Tur Toraks Der

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Lung transplantations in humans have been performed for almost 50 years. However, allograft rejection, non-rejection diseases such as harvest/reperfusion injury, infection, drug toxicity, post-transplant lymphoproliferative diseases, and recurrent disease are still significant complications. Although the clinical impression might suggest the possibility of any of these conditions, tissue diagnosis is usually necessary to establish a definitive diagnosis. This article mainly focuses on reviewing the morphological features of lung allograft rejection and its grading according to the revised 2007 ISHLT consensus classification of allograft rejection. Acute and chronic alloreactive injuries affect both the vasculature and the airways. Currently, the guidelines of the 2007 ISHLT consensus conference are used for the histolopathologic assessment of rejection. Although antibody mediated rejection is recognized in heart and kidney transplants, at present, there is no consensus about its diagnosis in transplanted lungs. Mimickers of rejection and posttransplant diseases will also be discussed. The collaboration between the transplant clinician and pathologist cannot be overemphasized to establish an optimal treatment for the individual patient following lung transplantation. (

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Diagnostic yield and therapeutic impact of flexible bronchoscopy in lung transplant recipients

Cited by 29 publications

References 0 publications

Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?

Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?

Invasive Diagnostic Strategies in Immunosuppressed Patients with Acute Respiratory Distress Syndrome

The Pathology of Lung Allograft Rejection: A Concise Review

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