Optimization of Transbronchial Cryobiopsy in Lung Transplant Recipients

Loor, Karina; Culebras, Mario; Sansano, Irene; Álvarez, Antonio; Berastegui, Cristina; Gracia, Javier de

doi:10.1016/j.athoracsur.2019.04.096

Cited by 21 publications

(12 citation statements)

References 26 publications

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“…Since 2015, similar complication rates were described in different studies [34][35][36]. The incidence of mild bleeding in TCB groups ranged between 7.5% and 22.5%, except for Gershmann et al, who reported the incidence as 2.5%.…”

Section: Tbb Versus Tcbsupporting

confidence: 52%

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

Mohamed¹,

Tosi²,

Pieropan³

et al. 2020

OBM Transplantation

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Pulmonary transplantation (LuTx) is established as a treatment option for patients with end-stage lung diseases, such as chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, and pulmonary arterial hypertension. Acute rejection and infection are implicated as potential risk factors in developing complications such as bronchiolitis obliterans syndrome (BOS) and chronic rejection, leading to high morbidity and mortality rates after the LuTx. Thus, surveillance procedures after transplantation are crucial to prevent further complications. Clinical monitoring is done through pulmonary function tests and procedural methods such as surveillance bronchoscopy and transbronchial biopsy of lung allografts, which are the most commonly used diagnostic tests. In this review, we aim to analyze the role of bronchoscopy as a surveillance procedure in determining the presence of infection or rejection as well as the management of airway complications after LuTx. We have also discussed the risk and benefit ratio of standard transbronchial biopsy (TBB) and transbronchial cryobiopsy (TCB) as routine performance after LuTx.

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Section: Tbb Versus Tcbsupporting

confidence: 52%

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

Mohamed¹,

Tosi²,

Pieropan³

et al. 2020

OBM Transplantation

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“…Further, although a Sensitivity > 90% of TBBx for detection of ACR ≥ ISHLT grade A2 has been reported, 10.8% of procedures were associated with complications that could limit adequate tissue sampling for histopathologic interpretation [17]. Modified FOB techniques have recently been implemented that enhance the adequacy of lung tissue specimens in 96.6% of procedures, however were also associated with moderate-severe hemorrhage and pneumothorax in 7.5% and 7.7%, respectively [18]. Therefore, implementation of dd-cfDNA as a plasma biomarker of allograft "tissue injury" [18].…”

Section: Discussionmentioning

confidence: 99%

“…Modified FOB techniques have recently been implemented that enhance the adequacy of lung tissue specimens in 96.6% of procedures, however were also associated with moderate-severe hemorrhage and pneumothorax in 7.5% and 7.7%, respectively [18]. Therefore, implementation of dd-cfDNA as a plasma biomarker of allograft "tissue injury" [18]. Therefore, a clinically validated plasma biomarker of rejection with "tissue injury" should be valuable as a tool for LT clinical care and surveillance.…”

Section: Discussionmentioning

confidence: 99%

Donor-derived, cell-free DNA levels by next-generation targeted sequencing are elevated in allograft rejection after lung transplantation

et al. 2020

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Surveillance after lung transplantation (LT) is critical to the detection of acute cellular rejection (ACR) and prevention of Chronic Lung Allograft Dysfunction (CLAD). Therefore, we measured donor-derived cell-free DNA (dd-cfDNA) implementing a clinical-grade, next generation targeted sequencing assay in 107 plasma samples from 38 unique LT recipients with diagnostic cohorts classified as: (1) Biopsy-confirmed or treated acute cellular rejection (ACR), (2) antibody-mediated rejection (AMR), (3) Obstructive chronic lung allograft dysfunction (CLAD), (4) allograft infection (INFXN), and (5) Stable healthy allografts (STABLE). Our principal findings: (1) dd-cfDNA level was elevated in ACR (median 0.91%; IQR: 0.39–2.07%), CLAD (2.06%; IQR: 0.57–3.67%), and an aggregated cohort of rejection encompassing allograft injury (1.06%; IQR :0.38–2.51%), compared with the STABLE cohort (0.38%; IQR: 0.23–0.87%) (p=0.02). (2) dd-cfDNA level with AMR was elevated (1.34%; IQR: 0.34–2.40%) compared to STABLE although did not reach statistical significance (p=0.07) due to limitations in sample size. (3) No difference in dd-cfDNA for allograft INFXN (0.39%; IQR: 0.18–0.67%) versus STABLE, that may relate to differences in “tissue injury” with spectrum of bronchial colonisation versus invasive infection. (4) No difference for dd-cfDNA in unilateral versus bilateral LT. (5) “Optimal Threshold” for dd-cfDNA for aggregated rejection events representing allograft injury was determined as 0.85%, with Sensitivity=55.6%, Specificity=75.8%, Positive Predictive Value (PPV)=43.3%, and Negative Predictive Value (NPV)=83.6%. Measurement of plasma dd-cfDNA may be a clinically useful tool for the assessment of lung allograft health and surveillance for “tissue injury” with a spectrum of rejection.

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“…ACR rates in year 1 were high than in TBB cohorts at 42%, almost half of whom were asymptomatic. Of this sub-group two-thirds were ≥ A2 (80).…”

Section: Gold Standard or Shades Of Grey?mentioning

confidence: 93%

Surveillance for acute cellular rejection after lung transplantation

2020

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Acute cellular rejection (ACR) is a common complication following lung transplantation (LTx), affecting almost a third of recipients in the first year. Established, comprehensive diagnostic criteria exist but they necessitate allograft biopsies which in turn increases clinical risk and can pose certain logistical and economic problems in service delivery. Undermining these challenges further, are known problems with inter-observer interpretation of biopsies and uncertainty as to the long-term implications of milder or indeed asymptomatic episodes. Increased risk of chronic lung allograft dysfunction (CLAD) has long been considered the most significant consequence of ACR. Consensus is lacking as to whether this applies to mild ACR, with contradictory evidence available. Given these issues, research into alternative, minimal or noninvasive biomarkers represents the main focus of research in ACR. A number of potential markers have been proposed, but none to date have demonstrated adequate sensitivity and specificity to allow translation from bench to bedside.

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Optimization of Transbronchial Cryobiopsy in Lung Transplant Recipients

Cited by 21 publications

References 26 publications

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

Donor-derived, cell-free DNA levels by next-generation targeted sequencing are elevated in allograft rejection after lung transplantation

Surveillance for acute cellular rejection after lung transplantation

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