title: The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease.
abstract: BACKGROUND
  The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates.
  
  
  METHODS
  This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality.
  
  
  RESULTS
  From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality.
  
  
  CONCLUSIONS
  OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil;; Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Daniere Yurie Vieira
authors.initials: DY
authors.lastname: Tomotani
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil;; Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Antônio Tonete
authors.initials: AT
authors.lastname: Bafi
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo Souza
authors.initials: ES
authors.lastname: Pacheco
authors.affiliation: Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Tainá Veras
authors.initials: TV
authors.lastname: de Sandes-Freitas
authors.affiliation: Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Laila Almeida
authors.initials: LA
authors.lastname: Viana
authors.affiliation: Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Edgar Porto
authors.initials: EP
authors.lastname: de Oliveira Pontes
authors.affiliation: Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Nikkei
authors.initials: N
authors.lastname: Tamura
authors.affiliation: Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Hélio
authors.initials: H
authors.lastname: Tedesco-Silva
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil;; Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
authors.forename: Flávio Geraldo Rezende
authors.initials: FG
authors.lastname: Freitas
keywords: Open lung biopsy (OLB); critical care; immunosuppression; kidney transplantation; lung diseases; organ transplantation