title: Surveillance transbronchial biopsies in infant lung and heart-lung transplant recipients.
abstract: There are limited published data on surveillance TBB for the identification of allograft rejection in infants after lung or heart-lung transplantation. We performed a retrospective review of children under one yr of age who underwent lung or heart-lung transplant at our institution. Since 2005, four infants were transplanted (three heart-lung and one lung). The mean age (±s.d.) at the time of transplant was 5.5 ± 2.4 (range 3-8) months. A total of 16 surveillance TBB procedures were completed in both inpatient and outpatient settings, with a range of 3-7 performed per patient. A minimum of five acceptable tissue pieces with expanded alveoli were obtained in 81% (13/16) of TBB procedures and a minimum of three pieces in 88% (14/16). There was no evidence of acute allograft rejection in 88% (14/16) of TBB procedures. One TBB procedure yielded two tissue specimens demonstrating A2 acute allograft rejection. One TBB procedure failed to yield tissue with sufficient alveoli. Additionally, B-grade assessment identified B0 in 50% (8/16), B1R in 12% (2/16), and BX (ungradeable or insufficient sample) in 38% (6/16) of biopsy procedures, respectively. In conclusion, TBB may be safely performed as an inpatient and outpatient procedure in infant lung and heart-lung transplant recipients and may provide adequate tissue for detecting acute allograft rejection and small airway inflammation.
authors: Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Don
authors: D
authors: Hayes
authors: Peter B
authors: PB
authors: Baker
authors: Benjamin T
authors: BT
authors: Kopp
authors: Stephen
authors: S
authors: Kirkby
authors: Mark
authors: M
authors: Galantowicz
authors: Patrick I
authors: PI
authors: McConnell
authors: Todd L
authors: TL
authors: Astor
mesh_terms: D001706:Biopsy / Q000379:methods; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy; D005260:Female; D006084:Graft Rejection; D016041:Heart-Lung Transplantation; D006801:Humans; D007223:Infant; D007249:Inflammation; D007297:Inpatients; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation; D008297:Male; D010045:Outpatients; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute rejection; bronchoscopy; flexible; heart-lung transplantation; infant; lung transplantation; outpatient procedure; surveillance; transbronchial biopsies