The utility of open lung biopsy following lung transplantation

Background: Most pulmonary complications associated with lung transplantati on have non-specific clinical characteristics. Furthermore, common diagnost ic modalities, including bronchoscopy with transbronchial biopsy (TBB), oft en do not render a definitive diagnosis. In this study, we reviewed our exp erience with open lung biopsy (OLB) following lung transplantation, specifi cally regarding its ability to safely provide clinically relevant informati on that affects therapeutic decisions. Methods: From October 1989 to March 2000, 202 patients underwent lung trans plantation at our institution. We reviewed the clinical course of the 42 pa tients who received 48 OLBs. Of these patients, we determined the pre-opera tive clinical condition, preceding TBB histologic information, OLB histolog y, treatment changes, and procedural complications as a result of the OLB. Results: A new, clinically unsuspected diagnosis was made in 14 biopsies (2 9% of all OLB), and all of these resulted in therapy changes. Thirty-two bi opsies (67% of all OLB) confirmed our clinical suspicions, and new therapy was initiated in 30 of these patients. Two patients (4% of all OLB) had non -diagnostic OLB. Four biopsies (8% of all OLB), including the 2 non-diagnos tic OLBs, did not result in any therapy changes or initiation of new therap y. Complications occurred in 3 patients, all of whom had an air leak for >7 days. Conclusion: Open lung biopsy in lung transplant patients renders a new, uns uspected diagnosis in nearly one third of patients and leads to specific, d irected therapy in the vast majority of patients. Open-lung biopsy can be p erformed safely and should be considered when diagnosis is uncertain in cli nically deteriorating patients.