title: Open lung biopsy for diffuse disease in patients with and without previously transplanted solid organs.
abstract: BACKGROUND
  Studies on whether surgical lung biopsy (SLB) modifies the treatment of patients with diffuse lung disease are conflicting, and information is limited on whether it alters treatment in solid-organ transplant recipients. Our objective was to determine and compare the rate of treatment change after SLB for diffuse lung disease in patients with and without a history of solid-organ transplantation.
  
  
  METHODS
  Patients undergoing SLB for diffuse lung disease between March 2004 and March 2009 were identified. A retrospective review was performed.
  
  
  RESULTS
  Sixty patients had SLB. Thirty-four patients (57%) had solid-organ transplantation. Twenty of 60 patients (33%) had a change in treatment as a result of the findings of the SLB. No significant differences in the treatment change rate were found between the transplant and nontransplant groups (10 of 34 versus 10 of 26; p = 0.46). Transplant patients were more likely to be on mechanical ventilation at the time of SLB (12 of 34 versus 3 of 26; p = 0.03). Mechanical ventilatory support at the time of SLB was associated with increased postoperative complications (odds ratio, 6.20; 95% confidence interval [CI], 1.70 to 22.66; p = 0.006) and in-hospital mortality (odds ratio, 9.75; 95% CI, 2.54 to 37.38; p = 0.001). Being on mechanical ventilation (hazard ratio, 3.91; 95% CI, 1.40 to 10.93; p = 0.009), a diagnosis of cancer (hazard ratio, 13.20; 95% CI, 2.87 to 60.78; p = 0.001), and a history of solid-organ transplantation (hazard ratio, 5.52; 95% CI, 1.08 to 28.14; p = 0.04) were independent predictors of survival.
  
  
  CONCLUSIONS
  Surgical lung biopsy changes treatment in one third of patients, with no significant difference between patients without transplantation and solid-organ transplant recipients. Patients who undergo SLB while on mechanical ventilation have a significantly increased risk of postoperative complications and death.
authors: Cardiovascular and Thoracic Surgery Division, Favaloro Foundation, Buenos Aires, Argentina. sdefranchi@ffavaloro.org
authors: Sebastian
authors: S
authors: Defranchi
authors: Alejandro M
authors: AM
authors: Bertolotti
authors: Carlos A
authors: CA
authors: Vigliano
authors: Jorge O
authors: JO
authors: Cáneva
authors: Juan M
authors: JM
authors: Ossés
authors: Pedro
authors: P
authors: González
authors: Roberto R
authors: RR
authors: Favaloro
mesh_terms: D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012189:Retrospective Studies