Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection.
BACKGROUND
Bronchoscopy with bronchoalveolar lavage (BAL) is the recommended initial invasive diagnostic procedure when lower respiratory tract infection is suspected in solid-organ transplant recipients. In this study, we evaluated the clinical impact and safety of bronchoscopy with BAL in heart transplant recipients.


METHODS
We reviewed all 44 consecutive diagnostic bronchoscopies with BAL that were performed in 35 heart transplant recipients at Helsinki University Central Hospital between May 1988 and December 2001.


RESULTS
Bronchoscopy findings established specific microbiologic diagnoses in 18 of 44 (41%) cases, and 14 of 44 (32%) bronchoscopic findings led to changes in therapy. The diagnostic yield of bronchoscopy from 1 to 6 months after transplantation was 73%, significantly better (p = 0.002) than diagnostic yield during the first month (18%) and after 6 months (28%). Pneumocystis carinii and cytomegalovirus were the most frequently detected pathogens in the BAL fluid. Cytomegalovirus pneumonia carried a high mortality rate (44%), whereas all patients with P carinii pneumonia recovered. Fourteen episodes were diagnosed as bacterial pneumonia, but because of empiric antibiotic therapy that was started widely before bronchoscopy, a microbiologic diagnosis was established in only 1 case. However, all patients with community-acquired pneumonia responded to empiric therapy. Four cases of major complications occurred after bronchoscopy, all cardiovascular but none fatal.


CONCLUSIONS
Bronchoscopy with BAL is a useful diagnostic tool in heart transplant recipients, especially between 1 and 6 months after transplantation.
Lehto
Juho T
JT
Respiratory Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. juho.lehto@hus.fi
Anttila
Veli-Jukka
VJ
Lommi
Jyri
J
Nieminen
Markku S
MS
Harjula
Ari
A
Taskinen
Eero
E
Tukiainen
Pentti
P
Halme
Maija
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D003587:Cytomegalovirus / Q000302:isolation & purification; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000382:microbiology; D011183:Postoperative Complications / Q000382:microbiology*; D012141:Respiratory Tract Infections / Q000382:microbiology*