title: Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study.
abstract: BACKGROUND
  Transbronchial biopsies using standard forceps (FTBBxs) are often limited by crush artifact and their small size. To date, there have been no studies aimed at assessing the safety and efficacy of cryoprobe biopsies (CPBxs) in the population of patients who have undergone lung transplants. We present the safety profile and biopsy results from the fi rst 21 procedures in a pilot study comparing CPBx to FTBBx in patients after lung transplantation.
  
  
  METHODS
  Patients who had undergone lung transplant and who were scheduled for bronchoscopy were sequentially enrolled between November 2011 and September 2012. Inclusion criteria included age . 18 years and bilateral, orthotopic lung transplant. Exclusion criteria were coagulopathy, FEV 1 < 0.8 L, diffuse bullous disease, hemodynamic instability, and severe hypoxemia (Pa(O2) < 55 mm Hg or Sp(O2) < 92% on room air). Twenty-one procedures were performed, 10 using rigid bronchoscopy followed by 11 via flexible bronchoscopy. Patients were monitored for complications including pneumothorax, hemodynamic instability, and/or respiratory distress. Bleeding was categorized on an adapted grading system.
  
  
  RESULTS
  Twenty-one procedures in 17 patients (median age: 52 years; 12 male patients) were performed. Specimen area and percent open alveoli were significantly greater using CPBx compared with FTBBx ( P < .05). No clinically significant procedural complications occurred and all patients were discharged the day of the procedure.
  
  
  CONCLUSIONS
  The use of the cryoprobe is a safe, alternative technique to FTBBx during post-lung transplant bronchoscopy. Further studies are needed to determine if larger samples obtained with CPBx translate to an increased diagnostic yield.
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. Electronic address: yarmus@jhmi.edu.
authors: Lonny
authors: L
authors: Yarmus
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors: Jason
authors: J
authors: Akulian
authors: Department of Pulmonary and Critical Care, Pennsylvania State University, Hershey, PA.
authors: Christopher
authors: C
authors: Gilbert
authors: Department of Pathology, Johns Hopkins University, Baltimore, MD.
authors: Peter
authors: P
authors: Illei
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors: Pali
authors: P
authors: Shah
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors: Christian
authors: C
authors: Merlo
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors: Jon
authors: J
authors: Orens
authors: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors: David
authors: D
authors: Feller-Kopman
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis; D001999:Bronchoscopy; D003452:Cryosurgery / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D014184:Transplantation, Homologous