title: Diagnostic bronchoscopy in solid-organ and hematopoietic stem cell transplantation.
abstract: Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes. This approach may be most critical when an underlying infectious etiology is suspected. In the absence of prompt diagnostic information on which to base effective treatment, the risks associated with empiric antimicrobial therapy, including medication side effects and the development of antibiotic resistance, compound the potential harm of delaying targeted management.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York.
authors.forename: Bianca
authors.initials: B
authors.lastname: Harris
authors.forename: Franklin David
authors.initials: FD
authors.lastname: Lowy
authors.forename: Diane Elizabeth
authors.initials: DE
authors.lastname: Stover
authors.forename: Selim Mehmet
authors.initials: SM
authors.lastname: Arcasoy
mesh_terms: D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D042241:Early Diagnosis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D016377:Organ Transplantation / Q000009:adverse effects*; D010043:Outcome and Process Assessment, Health Care; D062072:Patient Acuity; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis*; D018570:Risk Assessment; D061665:Time-to-Treatment