DIAGNOSTIC YIELD AND THERAPEUTIC IMPACT OF FLEXIBLE BRONCHOSCOPY IN LUNG-TRANSPLANT RECIPIENTS

Background: Bronchoalveolar lavage and transbronchial biopsy are often used for definitive diagnosis of lung rejection and infection in lung transplant recipients. Although protected specimen brushing is of val ue in nosocomial bacterial pneumonia, its role in lung transplant reci pients has not been widely reported. The aim of the study is to review the diagnostic yield and therapeutic impact of flexible bronchoscopy with the use of a combination of bronchoalveolar lavage, protected spe cimen brushing, and transbronchial biopsy in lung transplant recipient s. Methods: We reviewed flexible bronchoscopy data in 83 lung transpla nt recipients between February 1990 and March 1995. Only those with br onchoalveolar lavage, protected specimen brushing, and transbronchial biopsy were included in the analysis. There were 282 bronchoscopies pe rformed for clinically suspected lung rejection or infection (clinical bronchoscopy) and 35 bronchoscopies for follow-up of a previously det ected histologic abnormality (follow-up bronchoscopy). Results: The to tal yields for rejection and infection for clinical and follow-up bron choscopies were 67.4% and 57.9%, respectively. Acute rejection was det ected with transbronchial biopsy in 26.2% and 34.2% of clinical and fo llow-up bronchoscopies, respectively. Cytomegalovirus pneumonitis was detected with transbronchial biopsy in 4.0% and 11.4% of clinical and follow-up bronchoscopies, respectively. Overall, bacteria was the most common cause of lower respiratory tract infection. When used together , protected specimen brushing and bronchoalveolar lavage were compleme ntary techniques for detection of bacterial lower respiratory tract in fection with a significantly higher proportion detected with protected specimen brushing (greater than or equal to 10(3) colony forming unit s/ml) compared with bronchoalveolar lavage (greater than or equal to 1 0(5) colony forming units/ml) (p < 0.001). Complications were hemorrha ge (1.9%), pneumothorax (2.5%) and transient hypoxemia (10.5%). The re sults had an impact on management of rejection and infection in 57.8% of clinical and 39.5% of follow-up bronchoscopies. Conclusions: We con clude that bronchoscopy, with the use of a combination of bronchoalveo lar lavage, protected specimen brushing, and transbronchial biopsy, is safe with a high diagnostic yield and therapeutic impact for treating lung transplant recipients.