Lung Biopsy Evaluation of Acute Rejection Versus Opportunistic Infection in Lung Transplant Patients

Pt, Cagle; Truong, LD; Va, Holland; Ec, Lawrence; Gp, Noon; Sd, Greenberg

doi:10.1097/00007890-198904000-00026

Cited by 13 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The detection and treatment of acute pulmonary allograft rejection was the dominant reason why surveillance bronchoscopy with transbronchial lung biopsies was initially performed. [10][11][12][13][14][15] The model was the endomyocardial biopsy (EMBX) performed for the detection of cardiac rejection. In fact for the early heart-lung transplant (HLTx) patients only EMBX were performed until it was realized that the pulmonary allograft had not only asynchronous rejection but more aggressive rejection.…”

Section: Why We Should Do Surveillance Procedures Rejection and Lymphmentioning

confidence: 99%

“…Infection surveillance remains a vital part of the role of bronchoscopy, and there is little doubt that early detection of occult infection may lead to superior outcomes in individual patients. 13,37,38 However, less invasive methods such as multiplex polymerase chain reaction (PCR) testing of nasopharyngeal swabs and sensitive serum PCR testing for CMV have supplanted the former role of bronchoscopy in certain situations. 39 Nevertheless, selective surveillance for mycobacterial infections, chlamydia, and fungi, especially Aspergillus species as well as some herpes group viruses may allow prompt and effective therapy that prevents graft damage.…”

Section: Infectionmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Surveillance Bronchoscopy Post-Lung Transplantation

Glanville

2013

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Surveillance bronchoscopies with transbronchial lung biopsies (TBBx) are often performed post-lung transplantation, but the clinical value and impact on outcomes remain controversial. Given the cost and risks associated with TBBx, some centers only perform bronchoscopy for specific clinical indications or events. Although the presence of specific histological features (especially acute cellular rejection or lymphocytic bronchiolitis) have been associated with higher risk of chronic lung allograft rejection, the routine use of mandated TBBx has not been shown to alter clinical outcomes. However, prospective, randomized studies have not been done. Further, there are limited published data regarding the value of performing follow-up TBBx to ensure resolution of prior rejection events. On the other hand, putative benefits of TBBx include the ability to fine tune immune suppression and detect infection and large airway stenoses that may require more aggressive measures to minimize development of strictures and thereby prevent downstream post obstructive bronchiectasis. This review discusses the technique of TBBx, histological criteria for allograft rejection (acute and chronic), complications associated with TBBx (particularly pneumothoraces, hypoxemia, and bleeding), and putative benefits associated with mandated surveillance TBBx in this complex patient population.

show abstract

Section: Why We Should Do Surveillance Procedures Rejection and Lymphmentioning

confidence: 99%