PDF herunterladen
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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
02. Juli 2013 (online)

    Lizenzen und Reprints

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
 

  • References

  • 1 Glanville AR. The role of bronchoscopic surveillance monitoring in the care of lung transplant recipients. Semin Respir Crit Care Med 2006; 27 (5) 480-491
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Glanville AR. Bronchoscopic monitoring after lung transplantation. Semin Respir Crit Care Med 2010; 31 (2) 208-221
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Sandrini A, Glanville AR. The controversial role of surveillance bronchoscopy after lung transplantation. Curr Opin Organ Transplant 2009; 14 (5) 494-498
    CrossrefPubMedGoogle Scholar
  • 4 Chhajed PN, Tamm M, Glanville AR. Role of flexible bronchoscopy in lung transplantation. Semin Respir Crit Care Med 2004; 25 (4) 413-423
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Tamm M, Sharples LD, Higenbottam TW, Stewart S, Wallwork J. Bronchiolitis obliterans syndrome in heart-lung transplantation: surveillance biopsies. Am J Respir Crit Care Med 1997; 155 (5) 1705-1710
    CrossrefPubMedGoogle Scholar
  • 6 Stewart S, Fishbein MC, Snell GI , et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection. J Heart Lung Transplant 2007; 26 (12) 1229-1242
    CrossrefPubMedGoogle Scholar
  • 7 Yousem SA, Berry GJ, Cagle PT , et al. Revision of the 1990 working formulation for the classification of pulmonary allograft rejection: Lung Rejection Study Group. J Heart Lung Transplant 1996; 15 (1, Pt 1) 1-15
    PubMedGoogle Scholar
  • 8 Chhajed PN, Aboyoun C, Malouf MA, Hopkins PM, Plit ML, Glanville AR. Risk factors and management of bleeding associated with transbronchial lung biopsy in lung transplant recipients. J Heart Lung Transplant 2003; 22 (2) 195-197
    CrossrefPubMedGoogle Scholar
  • 9 Sato M, Waddell TK, Wagnetz U , et al. Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction. J Heart Lung Transplant 2011; 30 (7) 735-742
    CrossrefPubMedGoogle Scholar
  • 10 Higenbottam T, Stewart S, Penketh A, Wallwork J. The diagnosis of lung rejection and opportunistic infection by transbronchial lung biopsy. Transplant Proc 1987; 19 (5) 3777-3778
    PubMedGoogle Scholar
  • 11 Hutter JA, Stewart S, Higenbottam T, Scott JP, Wallwork J. Histologic changes in heart-lung transplant recipients during rejection episodes and at routine biopsy. J Heart Transplant 1988; 7 (6) 440-444
    PubMedGoogle Scholar
  • 12 Tazelaar HD, Prop J, Nieuwenhuis P, Billingham ME, Wildevuur CR. Airway pathology in the transplanted rat lung. Transplantation 1988; 45 (5) 864-869
    CrossrefPubMedGoogle Scholar
  • 13 Cagle PT, Truong LD, Holland VA, Lawrence EC, Noon GP, Greenberg SD. Lung biopsy evaluation of acute rejection versus opportunistic infection in lung transplant patients. Transplantation 1989; 47 (4) 713-715
    CrossrefPubMedGoogle Scholar
  • 14 Clelland CA, Higenbottam TW, Otulana BA , et al. Histological grading of acute lung rejection on transbronchial biopsy helps predict long-term outcome of heart-lung transplants. Transplant Proc 1990; 22 (4) 1480
    PubMedGoogle Scholar
  • 15 Clelland CA, Higenbottam TW, Stewart S, Scott JP, Wallwork J. The histological changes in transbronchial biopsy after treatment of acute lung rejection in heart-lung transplants. J Pathol 1990; 161 (2) 105-112
    CrossrefPubMedGoogle Scholar
  • 16 Glanville AR, Imoto E, Baldwin JC, Billingham ME, Theodore J, Robin ED. The role of right ventricular endomyocardial biopsy in the long-term management of heart-lung transplant recipients. J Heart Transplant 1987; 6 (6) 357-361
    PubMedGoogle Scholar
  • 17 Higenbottam T, Hutter JA, Stewart S, Wallwork J. Transbronchial biopsy has eliminated the need for endomyocardial biopsy in heart-lung recipients. J Heart Transplant 1988; 7 (6) 435-439
    PubMedGoogle Scholar
  • 18 Gordon IO, Bhorade S, Vigneswaran WT, Garrity ER, Husain AN. SaLUTaRy: survey of lung transplant rejection. J Heart Lung Transplant 2012; 31 (9) 972-979
    CrossrefPubMedGoogle Scholar
  • 19 Field AS, Paik JY, Stark D , et al. Myositis due to the microsporidian Anncaliia (Brachiola) algerae in a lung transplant recipient. Transpl Infect Dis 2012; 14 (2) 169-176
    CrossrefPubMedGoogle Scholar
  • 20 Burton CM, Iversen M, Scheike T, Carlsen J, Andersen CB. Minimal acute cellular rejection remains prevalent up to 2 years after lung transplantation: a retrospective analysis of 2697 transbronchial biopsies. Transplantation 2008; 85 (4) 547-553
    CrossrefPubMedGoogle Scholar
  • 21 Levvey BJ, Harkess M, Hopkins P , et al. Excellent clinical outcomes from a national donation-after-determination-of-cardiac-death lung transplant collaborative. Am J Transplant 2012; 12 (9) 2406-2413
    CrossrefPubMedGoogle Scholar
  • 22 Glanville AR, Aboyoun CL, Havryk A, Plit M, Rainer S, Malouf MA. Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. Am J Respir Crit Care Med 2008; 177 (9) 1033-1040
    CrossrefPubMedGoogle Scholar
  • 23 Burton CM, Iversen M, Scheike T, Carlsen J, Andersen CB. Is lymphocytic bronchiolitis a marker of acute rejection? An analysis of 2,697 transbronchial biopsies after lung transplantation. J Heart Lung Transplant 2008; 27 (10) 1128-1134
    CrossrefPubMedGoogle Scholar
  • 24 Aboyoun CL, Tamm M, Chhajed PN , et al. Diagnostic value of follow-up transbronchial lung biopsy after lung rejection. Am J Respir Crit Care Med 2001; 164 (3) 460-463
    CrossrefPubMedGoogle Scholar
  • 25 Valentine VG, Taylor DE, Dhillon GS , et al. Success of lung transplantation without surveillance bronchoscopy. J Heart Lung Transplant 2002; 21 (3) 319-326
    CrossrefPubMedGoogle Scholar
  • 26 Valentine VG, Gupta MR, Weill D , et al. Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation. J Heart Lung Transplant 2009; 28 (1) 14-20
    CrossrefPubMedGoogle Scholar
  • 27 Hopkins PM, Aboyoun CL, Chhajed PN , et al. Prospective analysis of 1,235 transbronchial lung biopsies in lung transplant recipients. J Heart Lung Transplant 2002; 21 (10) 1062-1067
    CrossrefPubMedGoogle Scholar
  • 28 Treede H, Glanville AR, Klepetko W , et al; European and Australian Investigators in Lung Transplantation. Tacrolimus and cyclosporine have differential effects on the risk of development of bronchiolitis obliterans syndrome: results of a prospective, randomized international trial in lung transplantation. J Heart Lung Transplant 2012; 31 (8) 797-804
    CrossrefPubMedGoogle Scholar
  • 29 Glanville AR. Breathing may be dangerous to your health: some days are more dangerous than others. Am J Transplant 2012; 12 (7) 1672-1673
    CrossrefPubMedGoogle Scholar
  • 30 Plit ML, Havryk AP, Hodgson A , et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J 2012;
    PubMedGoogle Scholar
  • 31 Glanville AR. Antibody-mediated rejection in lung transplantation: myth or reality?. J Heart Lung Transplant 2010; 29 (4) 395-400
    CrossrefPubMedGoogle Scholar
  • 32 Glanville AR. Antibody-mediated rejection in lung transplantation: turning myth into reality. J Heart Lung Transplant 2013; 32 (1) 12-13
    CrossrefPubMedGoogle Scholar
  • 33 Berry GJ, Brunt EM, Chamberlain D , et al; The International Society for Heart Transplantation. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung Rejection Study Group. J Heart Transplant 1990; 9 (6) 593-601
    PubMedGoogle Scholar
  • 34 Arcasoy SM, Berry G, Marboe CC , et al. Pathologic interpretation of transbronchial biopsy for acute rejection of lung allograft is highly variable. Am J Transplant 2011; 11 (2) 320-328
    CrossrefPubMedGoogle Scholar
  • 35 Stephenson A, Flint J, English J , et al. Interpretation of transbronchial lung biopsies from lung transplant recipients: inter- and intraobserver agreement. Can Respir J 2005; 12 (2) 75-77
    PubMedGoogle Scholar
  • 36 Chakinala MM, Ritter J, Gage BF , et al. Reliability for grading acute rejection and airway inflammation after lung transplantation. J Heart Lung Transplant 2005; 24 (6) 652-657
    CrossrefPubMedGoogle Scholar
  • 37 Wreghitt TG, Smyth RL, Scott JP , et al. Value of culture of biopsy material in diagnosis of viral infections in heart-lung transplant recipients. Transplant Proc 1990; 22 (4) 1809-1810
    PubMedGoogle Scholar
  • 38 Kurland G, Noyes BE, Jaffe R, Atlas AB, Armitage J, Orenstein DM. Bronchoalveolar lavage and transbronchial biopsy in children following heart-lung and lung transplantation. Chest 1993; 104 (4) 1043-1048
    CrossrefPubMedGoogle Scholar
  • 39 Tikkanen J, Lemström K, Halme M, Pakkala S, Taskinen E, Koskinen P. Cytological monitoring of peripheral blood, bronchoalveolar lavage fluid, and transbronchial biopsy specimens during acute rejection and cytomegalovirus infection in lung and heart—lung allograft recipients. Clin Transplant 2001; 15 (2) 77-88
    CrossrefPubMedGoogle Scholar
  • 40 Plit M, Pearson R, Havryk A, Da Costa J, Chang C, Glanville AR. Diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration compared with transbronchial and endobronchial biopsy for suspected sarcoidosis. Intern Med J 2012; 42 (4) 434-438
    CrossrefPubMedGoogle Scholar
  • 41 Cahill BC, Hibbs JR, Savik K , et al. Aspergillus airway colonization and invasive disease after lung transplantation. Chest 1997; 112 (5) 1160-1164
    CrossrefPubMedGoogle Scholar
  • 42 Costa C, Curtoni A, Bergallo M , et al. Quantitative detection of HHV-6 and HHV-7 in transbronchial biopsies from lung transplant recipients. New Microbiol 2011; 34 (3) 275-280
    PubMedGoogle Scholar
  • 43 Costa C, Delsedime L, Solidoro P , et al. Herpesviruses detection by quantitative real-time polymerase chain reaction in bronchoalveolar lavage and transbronchial biopsy in lung transplant: viral infections and histopathological correlation. Transplant Proc 2010; 42 (4) 1270-1274
    CrossrefPubMedGoogle Scholar
  • 44 Bergallo M, Costa C, Terlizzi ME , et al. Quantitative detection of the new polyomaviruses KI, WU and Merkel cell virus in transbronchial biopsies from lung transplant recipients. J Clin Pathol 2010; 63 (8) 722-725
    CrossrefPubMedGoogle Scholar
  • 45 Kramer MR, Denning DW, Marshall SE , et al. Ulcerative tracheobronchitis after lung transplantation: a new form of invasive aspergillosis. Am Rev Respir Dis 1991; 144 (3, Pt 1) 552-556
    CrossrefPubMedGoogle Scholar
  • 46 Thistlethwaite PA, Yung G, Kemp A , et al. Airway stenoses after lung transplantation: incidence, management, and outcome. J Thorac Cardiovasc Surg 2008; 136 (6) 1569-1575
    Google Scholar
  • 47 De Gracia J, Culebras M, Alvarez A , et al. Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation. Respir Med 2007; 101 (1) 27-33
    CrossrefPubMedGoogle Scholar
  • 48 Chhajed PN, Malouf MA, Glanville AR. Bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis. Intern Med J 2001; 31 (9) 512-516
    Google Scholar
  • 49 Yousem SA, Paradis I, Griffith BP. Can transbronchial biopsy aid in the diagnosis of bronchiolitis obliterans in lung transplant recipients?. Transplantation 1994; 57 (1) 151-153
    CrossrefPubMedGoogle Scholar
  • 50 Yousem SA, Paradis IL, Dauber JH, Griffith BP. Efficacy of transbronchial lung biopsy in the diagnosis of bronchiolitis obliterans in heart-lung transplant recipients. Transplantation 1989; 47 (5) 893-895
    CrossrefPubMedGoogle Scholar
  • 51 Chambers DC, Hodge S, Hodge G , et al. A novel approach to the assessment of lymphocytic bronchiolitis after lung transplantation—transbronchial brush. J Heart Lung Transplant 2011; 30 (5) 544-551
    CrossrefPubMedGoogle Scholar
  • 52 Cagle PT, Brown RW, Frost A, Kellar C, Yousem SA. Diagnosis of chronic lung transplant rejection by transbronchial biopsy. Mod Pathol 1995; 8 (2) 137-142
    PubMedGoogle Scholar
  • 53 Chhajed PN, Glanville AR. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med 2003; 24 (3) 511-516
    CrossrefPubMedGoogle Scholar
  • 54 Chhajed PN, Aboyoun C, Malouf MA , et al. Prophylactic nasopharyngeal tube insertion prevents acute hypoxaemia due to upper-airway obstruction during flexible bronchoscopy. Intern Med J 2003; 33 (7) 317-318
    CrossrefPubMedGoogle Scholar
  • 55 Chhajed PN, Aboyoun C, Malouf MA , et al. Management of acute hypoxemia during flexible bronchoscopy with insertion of a nasopharyngeal tube in lung transplant recipients. Chest 2002; 121 (4) 1350-1354
    CrossrefPubMedGoogle Scholar
  • 56 Chhajed PN, Aboyoun C, Chhajed TP , et al. Sedative drug requirements during bronchoscopy are higher in cystic fibrosis after lung transplantation. Transplantation 2005; 80 (8) 1081-1085
    CrossrefPubMedGoogle Scholar
  • 57 Bjørtuft O, Brosstad F, Boe J. Bronchoscopy with transbronchial biopsies: measurement of bleeding volume and evaluation of the predictive value of coagulation tests. Eur Respir J 1998; 12 (5) 1025-1027
    CrossrefPubMedGoogle Scholar
  • 58 Diette GB, Wiener CM, White Jr P. The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: results of a prospective cohort study. Chest 1999; 115 (2) 397-402
    CrossrefPubMedGoogle Scholar
  • 59 Findik S, Erkan L, Light RW. Iatrogenic bilateral pneumothorax following unilateral transbronchial lung biopsy. Br J Radiol 2006; 79 (943) e22-e24
    CrossrefPubMedGoogle Scholar