title: Role of open lung biopsy in lung transplant recipients in a single children's hospital: a 13-year experience.
abstract: BACKGROUND
  There are few data in the literature regarding the utility of open lung biopsy for the assessment of graft dysfunction after pediatric lung transplantation. The aim of this study is to review our experience with diagnostic open lung biopsy in lung transplant recipients in a children's hospital.
  
  
  METHODS
  Records of lung transplant recipients from January 1990 through December 2002 were reviewed to identify the indications, outcomes, and complications of open lung biopsy.
  
  
  RESULTS
  Two hundred twenty-four patients (mean age, 9.9 +/- 6.2 years; median age, 11 years; age range, 0.01-19.6 years) underwent 249 lung transplantations: 231 bilateral, 8 single, and 10 heart-lung transplantations. Mean follow-up was 3.4 years. One hundred three open lung biopsies were performed in 89 (40% of all recipients) patients. Thirteen recipients underwent open lung biopsy twice, and 1 recipient had 3 open lung biopsies. The indications for open lung biopsy were suspicion of bronchiolitis obliterans (n = 70), posttransplantation lymphoproliferative disorder (n = 15), infection (n = 8), and unexplained respiratory failure (n = 10). A new diagnosis was made in 49 biopsies (48%), 50 biopsies (49%) confirmed the preoperative clinical diagnosis, and 4 biopsies (3%) were nondiagnostic. Bronchiolitis obliterans was confirmed in 40 (57%) of 70 open lung biopsies, posttransplantation lymphoproliferative disorder was confirmed in 4 (27%) of 15 open lung biopsies, and infection was confirmed in 6 (75%) of 8 open lung biopsies. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. There was no mortality as a direct result of open lung biopsy. Eleven major complications and 22 minor complications occurred in 103 procedures.
  
  
  CONCLUSIONS
  Open lung biopsy can be performed safely, and established or confirmed a diagnosis in 97% of the cases. A change in therapy occurred in 69% of the cases as a result of the diagnosis made from open lung biopsy. In our experience open lung biopsy appears to be a useful tool.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Mo.
authors.forename: Cliff K
authors.initials: CK
authors.lastname: Choong
authors.forename: Fabio J
authors.initials: FJ
authors.lastname: Haddad
authors.forename: Charles B
authors.initials: CB
authors.lastname: Huddleston
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bell
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Guthrie
authors.forename: Eric N
authors.initials: EN
authors.lastname: Mendeloff
authors.forename: Pam
authors.initials: P
authors.lastname: Schuler
authors.forename: Maite
authors.initials: M
authors.lastname: De la Morena
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Sweet
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D016040:Lung Transplantation / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors