Study objectives: To establish whether a consensus exists among active
transplant centers regarding the use and interpretation of informatio
n obtained by surveillance bronchoscopic lung biopsy (SBLB). Design: P
rospective standardized questionnaire answered via mail and telephone
communications. Participants: A five page, 18-question survey was sent
to all lung transplant programs listed by the United Network of Organ
Sharing in North America, as well as eight selected international pro
grams. Ninety-one surveys were sent to 83 North American and eight int
ernational programs. Seventy-four programs (81%) responded. Seventeen
programs (19%) were excluded secondary to inactivity. The remaining 57
programs (63%) were included in final data analysis. Interventions: N
one. Results: Sixty-eight percent (39/57) of the responding programs p
et-form SBLBs. Ninety-two percent of the programs pet-forming SBLBs do
so within the first month, and 69% continue to do so on a regular bas
is. Sixty-nine percent (27/39) of programs performing SBLBs continue t
o do so after 1 year. Eighty-six percent (32/37) of respondents believ
e that SBLB impacts on patient management at least 10% of the time. Te
chnically, 90% (35/39) take biopsy specimens from more than one lobe p
er SBLB session. Fifty-nine percent (23/39) took 6 to 10 biopsy specim
ens per session, 33% (13/39) took three to five biopsy specimens, and
7% (4/39) took >10 biopsy specimens per session. Eighty-six percent (3
2/37) of the responding centers reported treating asymptomatic rejecti
on at grade 2A, while 14% (5/37) waited until histologic grade 3A befo
re beginning treatment. Complications from SBLB were minimal with <5%
rates of pneumothorax, requirement for chest tube placements, or signi
ficant bleeding during SBLB reported by >95% of the programs pet-formi
ng SBLB. Conclusion: Most active lung transplant centers perform SBLBs
and do so on a regular basis. However, a wide range of opinion exists
over the utility and technique of SBLB and the impact of its results
influencing outcome in the lung transplant recipient. To answer these
questions, a randomized multicentered trial or registry to determine t
he effect of SBLB on lung transplant recipient morbidity and mortality
is required.