ROLE OF OPEN LUNG-BIOPSY FOR DIAGNOSIS IN LUNG-TRANSPLANT RECIPIENTS - 10-YEAR EXPERIENCE

Between November 1983 and August 1993, The Toronto Lung Transplant Pro gram performed 153 transplantations in 144 recipients: 53 single-lung transplantations (SLT) and 100 double-lung transplantations (DLT). Thi rty-eight open lung biopsies (OLBs) were done in 32 (22% of all recipi ents): 19 in SLT (36% of SLT) 12 in DLT (12% of DLT), and 1 in a patie nt who had a SLT and then a double retransplantation. Six recipients u nderwent OLB twice: 1 DLT, 3 SLT, and 2 who had OLB both before and af ter retransplantation. Indication for 11 early OLBs (less than or equa l to 45 days postoperative) was persistent parenchymal infiltrates. In dications for 27 late OLBs (>45 days postoperative) included progressi ve radiologic disease with clinical findings or progressive loss of pu lmonary function (18), persistent poor graft function (3), mass or nod ules (3), persistent infiltrates without functional loss (2), and pers istent lymphocytosis in bronchoalveolar lavage (1). Open lung biopsy c onfirmed a previous clinical or pathologic diagnosis in II, suggested a diagnosis in 2, yielded nonspecific information in 16, and provided different diagnosis in 9. New diagnosis that changed therapy was made in 1 of 11 early OLBs and in 8 of 27 late OLBs. These 9 diagnoses incl uded in SLTs: bronchiolitis obliterans (2), bronchiolitis obliterans o rganizing pneumonia (1), malignant lymphoma (1), and chronic vascular rejection (1) in SLT, and bronchiolitis obliterans organizing pneumoni a (3) and Burkholderia cepacia infection (1) in DLT. We conclude that OLB is of little value in the perioperative period but yields useful i nformation in approximately 30% of patients when performed late.