THE UTILITY OF ANNUAL SURVEILLANCE BRONCHOSCOPY IN HEART-LUNG TRANSPLANT RECIPIENTS

Bronchoscopy with transbronchial biopsy (TBBx) and bronchoalveolar lav age (BAL) has an appreciable yield in detecting asymptomatic abnormali ties in heart-lung transplant recipients (HLTR) during the early posto perative period, The utility of annual surveillance procedures has not been critically evaluated. We reviewed all annual bronchoscopies perf ormed on 29 HLTR to determine the frequency of asymptomatic abnormalit ies. Surveillance bronchoscopies (SE) were performed on asymptomatic s ubjects with unchanged lung function compared with baseline. Surveilla nce/clinical bronchoscopies (SCB) were those performed in patients wit h stable decrements in lung function, Nineteen patients underwent 48 S B and 8 had 18 SCB. Five of 15 (33%) SE performed at one year yielded an abnormal TBBx (1 grade 2 acute rejection [AR], 1 grade 1 AR, 1 grad e 1 AR with obliterative bronchiolitis [OB] and 2 Pneumocystis carinii pneumonia), At 2 or more years, TBBx was abnormal in 2 of 33 (6%, p=0 .024 compared with first year TBBx) (1 grade 1 AR, 1 lymphocytic bronc hiolitis). Pathogens were identified in BAL in 19 (40%) SE. Fourteen ( 78%) SCB were abnormal. Nine (50%) revealed an abnormal TBBx (all OB), but only 2 (11%) of these altered patient management. Seven (39%) dem onstrated pathogens in BAL. We conclude that in HLTR (1) surveillance TBBx rarely yields positive findings 2 or more years posttransplant, ( 2) surveillance TBBx seldom alters management in patients with stable decrements in lung function, and (3) BAL is useful to screen for poten tial pathogens.