Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 460-463

Diagnostic Value of Follow-up Transbronchial Lung Biopsy after Lung Rejection

CHRISTINA L. ABOYOUN, MICHAEL TAMM, PRASHANT N. CHHAJED, PETER HOPKINS, MONIQUE A. MALOUF, STEPHEN RAINER, and ALLAN R. GLANVILLE

Cardiopulmonary Transplant Unit, St. Vincent's Hospital, Sydney, Australia

Although transbronchial lung biopsy (TBBx) is widely acknowledged as the "gold standard" for diagnosis of acute rejection, controversy exists regarding the need to perform follow-up procedures. Over a 5-yr period, we performed 1,142 TBBx of which 173 were follow-up TBBx in 99 patients with pulmonary allograft rejection greater than or equal to International Society for Heart and Lung Transplantation (ISHLT) grade A₂ on initial TBBx. Rejection on the previous 173 TBBx was associated with lymphocytic bronchiolitis/bronchitis (LBB)  ISHLT grade B₂ in 82 patients and with cytomegalovirus (CMV) pneumonitis in 16 patients. Persistent rejection ( A₂) was observed in 45 of 173 (26%) follow-up TBBx. Persistent B grade rejection ( B₂) was present in 28 patients whereas new B grade rejection developed in 11 patients with  A₂ grade rejection. Rejection  B₂ was significantly (p < 0.05) associated with rejection  A₂. Fifteen follow-up TBBx showed new B grade rejection without signs of  A₂ rejection. A new diagnosis of CMV pneumonitis was made in 33 of 173 (19%). CMV pneumonitis occurred in 35 follow-up TBBx, four associated with  A₂ rejection and eight with  B₂ rejection. The overall incidence of bronchiolitis obliterans syndrome (BOS) in both groups was similar. Patients with persistent rejection on follow-up TBBx developed BOS at a median of 1.3 yr and median of 2.0 yr (p = not significant [NS]) posttransplantation. The practice of follow-up TBBx after rejection within 2 yr posttransplant is clinically useful as it provides valuable diagnostic information.

Keywords: lung transplantation; rejection; transbronchial lung biopsy

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