M Tamm, LD Sharples, TW Higenbottam, S Stewart and J Wallwork
Department of Pathology, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, United Kingdom.

Transbronchial biopsies (TBBs) are useful to diagnose acute rejection and infection in patients with lung transplants. The value of routine surveillance biopsies (S-TBBs) is not known, and such biopsies with a clinical indication are not without risk and are expensive. One hundred twenty-six 6-mo survivors of heart-lung transplantation (HLT) were studied to determine the effect of stopping S-TBBs on the development of bronchiolitis obliterans syndrome (BOS) and subsequent survival. Fifty-one received transplants while S-TBB was part of routine care (group A), and 75 received transplants after this practice was stopped (group B). There was no difference in patient characteristics. Group A had shorter graft ischemia (p < 0.01) and longer postoperative ventilation (p < 0.01). Maintenance immunosuppression was similar, but group A had more steroid pulses in the second 6 mo after HLT (p < 0.01). The number of patients free from any functional deterioration at 49 to 60 mo after HLT declined to 39% in group A and 64% in group B. The risk of developing BOS grade 1 in group A relative to group B was 1.63 (95% confidence intervals: 0.96-2.79, p = 0.07). Patient survival was similar in the two groups. A total of 86 TBBs were taken in the absence of any signs or symptoms and had low diagnostic yield. In summary, there was no increased incidence of BOS after stopping S-TBBs.

This article has been cited by other articles:

				J.-F. Cordier Challenges in pulmonary fibrosis {middle dot} 2 : Bronchiolocentric fibrosis Thorax, July 1, 2007; 62(7): 638 - 649. [Abstract] [Full Text] [PDF]

				C Benden, O Harpur-Sinclair, A S Ranasinghe, J C Hartley, M J Elliott, and P Aurora Surveillance bronchoscopy in children during the first year after lung transplantation: is it worth it? Thorax, January 1, 2007; 62(1): 57 - 61. [Abstract] [Full Text] [PDF]

				R. M. Kotloff, V. N. Ahya, and S. W. Crawford Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 22 - 48. [Abstract] [Full Text] [PDF]

				C. L. Lau, G. A. Patterson, and S. M. Palmer Critical Care Aspects of Lung Transplantation J Intensive Care Med, March 1, 2004; 19(2): 83 - 104. [Abstract] [PDF]

				C.L. Lau and G.A. Patterson Current status of lung transplantation Eur. Respir. J., November 16, 2003; 22(47_suppl): 57S - 64s. [Abstract] [Full Text] [PDF]

				M. Reynaud-Gaubert, P. Thomas, R. Gregoire, M. Badier, P. Cau, J. Sampol, R. Giudicelli, and P. Fuentes Clinical utility of bronchoalveolar lavage cell phenotype analyses in the postoperative monitoring of lung transplant recipients Eur. J. Cardiothorac. Surg., January 1, 2002; 21(1): 60 - 66. [Abstract] [Full Text] [PDF]

				C. L. ABOYOUN, M. TAMM, P. N. CHHAJED, P. HOPKINS, M. A. MALOUF, S. RAINER, and A. R. GLANVILLE Diagnostic Value of Follow-up Transbronchial Lung Biopsy after Lung Rejection Am. J. Respir. Crit. Care Med., August 1, 2001; 164(3): 460 - 463. [Abstract] [Full Text] [PDF]

				S. J. Swanson, S. J. Mentzer, J. J. Reilly, R. Bueno, J. M. Lukanich, M. T. Jaklitsch, L. Kobzik, E. P. Ingenito, A. Fuhlbrigge, C. Donovan, et al. SURVEILLANCE TRANSBRONCHIAL LUNG BIOPSIES: IMPLICATION FOR SURVIVAL AFTER LUNG TRANSPLANTATION J. Thorac. Cardiovasc. Surg., January 1, 2000; 119(1): 27 - 38. [Abstract] [Full Text] [PDF]

				S. M. Arcasoy and R. M. Kotloff Lung Transplantation N. Engl. J. Med., April 8, 1999; 340(14): 1081 - 1091. [Full Text] [PDF]