Results of surveillance bronchoscopy after cadaveric lung transplantation: a Japanese single-institution study.
BACKGROUND
The prevention and early detection of post-transplantation rejection and infection are key clinical points to achieve long-term survival after lung transplantation. Although surveillance bronchoscopy (SB) is performed in many transplantation centers, it is still controversial because of its undefined clinical significance and its possible complications. We evaluated the clinical utility of SB after cadaveric lung transplantation in Japan, where bilateral transplantation is officially limited to patients medically requiring bilateral grafts.


METHODS
Twenty-eight patients who underwent cadaveric lung transplantation followed by SB were retrospectively analyzed with reference to the results of bronchoscopy. SB is routinely performed at 1, 2, 3, 6, and 12 months after lung transplantation and annually thereafter. Clinically indicated bronchoscopy (CIB) is considered in patients with suspected rejection or airway infection, and for follow-up examination after treatment for acute rejection.


RESULTS
There were 206 bronchoscopies, including 189 SBs and 17 CIBs, performed in 28 patients who underwent cadaveric lung transplantation between 2000 and 2013 at Osaka University Hospital. Among SBs, 92 (49%) showed positive results of transbronchial lung biopsy (TBLB) or bronchoalveolar lavage (BAL), and intervention was applied following 34 SBs (18%). Among CIBs, 8 (47%) showed positive results of TBLB or BAL, with intervention performed in 3 patients (18%). A2-3 and B2R findings according to the revised International Society for Heart and Lung Transplantation (ISHLT) rejection score and airway infection/colonization were frequently observed within a year following lung transplantation. Cytomegalovirus infection was found in 7 SBs (6%) by TBLB only within 2 months after transplantation. Regarding complications, moderate bleeding occurred in 21 (11%), pneumothorax in 2 (1%), prolonged hypoxemia in 1 (0.5%), and pneumonia in 1 (0.5%) among the 189 SBs.


CONCLUSIONS
SB frequently detects rejection and airway infection or colonization with minimum complications, especially within 12 months after cadaveric lung transplantation.
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: mi@thoracic.med.osaka-u.ac.jp.
M
M
Inoue
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
M
M
Minami
Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan.
N
N
Wada
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
T
T
Nakagiri
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
S
S
Funaki
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
T
T
Kawamura
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Y
Y
Shintani
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
M
M
Okumura
D000293:Adolescent; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid; D001999:Bronchoscopy / Q000379:methods*; D002102:Cadaver; D005260:Female; D006801:Humans; D007564:Japan; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult