Abstract
Background
The utility of surveillance bronchoscopy for the clinical management of lung transplant recipients is undefined. This study evaluates the role of surveillance bronchoscopy in the monitoring and care of lung transplant recipients.
Methods
We retrospectively analyzed all lung transplant recipients who had surveillance bronchoscopy at Henry Ford Hospital in Detroit, Michigan between August 2014 and August 2019. Bronchoscopies performed for clinical symptoms, new radiographic abnormalities, and to assess stents or acute rejection were excluded. A total of 107 lung transplant recipients and 449 bronchoscopies were analyzed. The primary outcome was rate of change in clinical care based on microbiologic and pathologic test results. Secondary outcomes were rates of microbiologic and pathologic test positivity and rates of adverse effects.
Results
The most common microbiologic tests performed on bronchoalveolar lavage were bacterial (96.9%), fungal (95.3%), and acid-fast bacillus (95.1%) stains and cultures. Of 2,560 microbiologic tests, 22.0% were positive and resulted in therapy changes for 2.9%. Positive galactomannan, acid-fast bacillus tests, and Pneumocystis jirovecii antigen/PCR did not result in therapy changes. Of the 370 transbronchial biopsies performed, 82.2% were negative for acute rejection and 13% were positive for A1/A2 rejection. Immunosuppressive therapy changes occurred after 15.8% with reduction in immunosuppression due to positive microbiologic tests in 16.9%. Adverse events occurred in 8.0% of patients.
Conclusion
Diagnostic stewardship is warranted when performing surveillance bronchoscopy in lung transplant recipients.
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