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Semin Respir Crit Care Med 2013; 34(03): 414-420
DOI: 10.1055/s-0033-1348466
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of Surveillance Bronchoscopy Post–Lung Transplantation

Allan R. Glanville
1   The Lung Transplant Unit, St. Vincent's Hospital, New South Wales, Sydney
› Author Affiliations
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Publication History

Publication Date:
02 July 2013 (online)

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Abstract

Surveillance bronchoscopies with transbronchial lung biopsies (TBBx) are often performed post–lung transplantation, but the clinical value and impact on outcomes remain controversial. Given the cost and risks associated with TBBx, some centers only perform bronchoscopy for specific clinical indications or events. Although the presence of specific histological features (especially acute cellular rejection or lymphocytic bronchiolitis) have been associated with higher risk of chronic lung allograft rejection, the routine use of mandated TBBx has not been shown to alter clinical outcomes. However, prospective, randomized studies have not been done. Further, there are limited published data regarding the value of performing follow-up TBBx to ensure resolution of prior rejection events. On the other hand, putative benefits of TBBx include the ability to fine tune immune suppression and detect infection and large airway stenoses that may require more aggressive measures to minimize development of strictures and thereby prevent downstream post obstructive bronchiectasis. This review discusses the technique of TBBx, histological criteria for allograft rejection (acute and chronic), complications associated with TBBx (particularly pneumothoraces, hypoxemia, and bleeding), and putative benefits associated with mandated surveillance TBBx in this complex patient population.

Keywords

bronchoscopy - transbronchial biopsy - rejection - lung transplantation
 

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