title: Transbronchial cryo-biopsy in lung transplantation patients: first report.
abstract: OBJECTIVE
  Transbronchial lung biopsies remain the gold standard to establish the presence of allograft rejection or infection after lung transplantation. The aim of this study was to evaluate the efficacy and safety of cryo-transbronchial biopsies (cryo-TBB) in lung transplantation patients.
  
  
  METHODS
  Forty lung transplantation patients (mean age 58.3 years) underwent cryo-TBB, either routine post lung transplantation surveillance bronchoscopy (n = 27), or clinically indicated bronchoscopy (n = 13). During the procedure, two to three biopsy samples were taken. Procedure characteristics, complications and the diagnostic yield were compared with 40 matched controls who underwent conventional forceps-TBB.
  
  
  RESULTS
  No major complications occurred in the cryo-TBB group. The mean diameter of the specimen taken by cryo-TBB was 10 mm(2) compared with only 2 mm(2) using forceps-TBB (P < 0.05). The increased size and quality of biopsy samples in the study group translated to a significant increase in the percentage of alveolated tissue (65% vs 34% respectively, P < 0.05) that enabled a clear histological detection of acute rejection (n = 4), pneumonitis (n = 3), diffuse alveolar damage (n = 1) and confident exclusion of acute rejection, infection or pneumonitis (n = 32). Fluoroscopy time was significantly shorter in the cryo-biopsy patients compared with controls (25 s vs 90 s, respectively, P < 0.05).
  
  
  CONCLUSIONS
  Cryo-TBB for both surveillance and clinically indicated bronchoscopy in lung transplantation patients provides larger and more diagnostic lung parenchyma specimens with low complication rate and shorter intervention time than traditional forceps biopsies.
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel. orenfr@clalit.org.il
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.forename: Ludmila
authors.initials: L
authors.lastname: Fridel
authors.forename: Dror
authors.initials: D
authors.lastname: Rosengarten
authors.forename: Yael
authors.initials: Y
authors.lastname: Raviv
authors.forename: Viktoria
authors.initials: V
authors.lastname: Rosanov
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000328:Adult; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D017679:Cryotherapy / Q000379:methods*; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis / Q000473:pathology; D016040:Lung Transplantation; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies