Bronchiolitis obliterans syndrome in heart-lung transplantation: surveillance biopsies.
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.
Tamm
M
M
Department of Pathology, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, United Kingdom.
Sharples
L D
LD
Higenbottam
T W
TW
Stewart
S
S
Wallwork
J
J
D000206:Actuarial Analysis; D000328:Adult; D001707:Biopsy, Needle / Q000009:adverse effects; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D016041:Heart-Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015996:Survival Rate