title: Invasive biopsy is effective and useful after lung transplant.
abstract: BACKGROUND
  Transbronchial biopsy (TBB) is widely used after lung transplant but may not be diagnostic. Our group has used invasive approaches, open lung biopsy (OLB) or video-assisted thoracoscopy (VAT), to establish a definitive diagnosis in unexplained clinical deterioration. We sought to demonstrate the risks and benefits of this approach.
  
  
  METHODS
  A retrospective review was made of the case notes of the patients undergoing OLB or VAT during a 12-year period from August 1996.
  
  
  RESULTS
  During a 12-year period in 442 recipients, there were 51 invasive biopsies in 45 patients (6 had 2 procedures), of which 41 (80%) were OLB and 10 (20%) were VAT. Time of biopsy ranged from 7 days to 11 years after transplant. Thirty-seven (73%) took place in the first year, including 12 (24%) within the first 30 days. Nine patients died within 30 days of biopsy; 7 of them were already ventilated. Overall, biopsy provided a new unsuspected diagnosis in 37% of patients and confirmed the diagnostic suspicion in 47%. In only 16% of patients did it fail to provide a result that was clinically useful. The results of 29 (57%) biopsies led to a change in treatment. Sixty-three percent of new diagnoses and 71% where clinical suspicion was confirmed resulted in a treatment change. In all but 2 cases, a change was made to medication.
  
  
  CONCLUSIONS
  In this large series of invasive biopsies, there was a high rate of useful results, with a frequent change in treatment. Invasive biopsies are a safe intervention in ambulatory patients.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. clare.burdett@ncl.ac.uk
authors.forename: Clare L
authors.initials: CL
authors.lastname: Burdett
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Critchley
authors.forename: Fiona
authors.initials: F
authors.lastname: Black
authors.forename: Sion
authors.initials: S
authors.lastname: Barnard
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Clark
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
authors.forename: Kate F
authors.initials: KF
authors.lastname: Gould
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.forename: John H
authors.initials: JH
authors.lastname: Dark
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis / Q000473:pathology; D016040:Lung Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult