Role of Clinically Indicated Transbronchial Lung Biopsies in the Management of Pediatric Post-Lung Transplant Patients

Christina L. Greene, Brian Reemtsen, Anastasios Charalanpos Polimenakos, Monica Horn, Winfield Wells

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Although transbronchial biopsy (TBB) is the definitive method for diagnosing graft dysfunction after pediatric lung transplantation, concern over procedural complications has limited its use. We reviewed our institutional experience with clinically indicated TBB to determine its safety and efficacy with emphasis on how biopsy findings altered management. Methods: A retrospective chart review was done of 61 pediatric lung transplantation patients undergoing 179 TBB procedures. Data were collected on pre-TBB symptoms, pulmonary function testing, and imaging studies. The prebiopsy diagnosis was noted and compared with the findings from TBB to see how frequently treatment changed after biopsy. Results: Age at TBB ranged from 2 months to 20 years, with an average of 3 biopsies per patient. There was no procedure-related mortality. The incidence of complications was 9% and included important bleeding with spontaneous resolution in 6% and pneumothorax in 3%. The usual indication for TBB was a change in the chest roentgenogram, frequently accompanied by a decrease in flows on spirometry. The TBB specimens were adequate for pathologic analysis 92% of the time, and a specific pathologic diagnosis could be made in 54% of cases. The findings from TBB altered the clinical management of the patient 64% of the time. Conclusions: In pediatric lung transplant recipients presenting with graft dysfunction, TBB is a low-risk diagnostic procedure that yields clinically useful information in a majority of cases. In our experience, the findings from TBB altered medical treatment in 64% of patients. Treatment was most often changed in the group diagnosed with rejection as the probable cause of graft dysfunction.

Original languageEnglish (US)
Pages (from-to)198-203
Number of pages6
JournalAnnals of Thoracic Surgery
Volume86
Issue number1
DOIs
StatePublished - Jul 1 2008
Externally publishedYes

Fingerprint

Pediatrics
Transplants
Biopsy
Lung
Lung Transplantation
Spirometry
Pneumothorax
Thorax
Therapeutics
Hemorrhage
Safety
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

Role of Clinically Indicated Transbronchial Lung Biopsies in the Management of Pediatric Post-Lung Transplant Patients. / Greene, Christina L.; Reemtsen, Brian; Polimenakos, Anastasios Charalanpos; Horn, Monica; Wells, Winfield.

In: Annals of Thoracic Surgery, Vol. 86, No. 1, 01.07.2008, p. 198-203.

Research output: Contribution to journalArticle

@article{afd1d7f3e1624e49a92e00a9ae7aec4c,
title = "Role of Clinically Indicated Transbronchial Lung Biopsies in the Management of Pediatric Post-Lung Transplant Patients",
abstract = "Background: Although transbronchial biopsy (TBB) is the definitive method for diagnosing graft dysfunction after pediatric lung transplantation, concern over procedural complications has limited its use. We reviewed our institutional experience with clinically indicated TBB to determine its safety and efficacy with emphasis on how biopsy findings altered management. Methods: A retrospective chart review was done of 61 pediatric lung transplantation patients undergoing 179 TBB procedures. Data were collected on pre-TBB symptoms, pulmonary function testing, and imaging studies. The prebiopsy diagnosis was noted and compared with the findings from TBB to see how frequently treatment changed after biopsy. Results: Age at TBB ranged from 2 months to 20 years, with an average of 3 biopsies per patient. There was no procedure-related mortality. The incidence of complications was 9{\%} and included important bleeding with spontaneous resolution in 6{\%} and pneumothorax in 3{\%}. The usual indication for TBB was a change in the chest roentgenogram, frequently accompanied by a decrease in flows on spirometry. The TBB specimens were adequate for pathologic analysis 92{\%} of the time, and a specific pathologic diagnosis could be made in 54{\%} of cases. The findings from TBB altered the clinical management of the patient 64{\%} of the time. Conclusions: In pediatric lung transplant recipients presenting with graft dysfunction, TBB is a low-risk diagnostic procedure that yields clinically useful information in a majority of cases. In our experience, the findings from TBB altered medical treatment in 64{\%} of patients. Treatment was most often changed in the group diagnosed with rejection as the probable cause of graft dysfunction.",
author = "Greene, {Christina L.} and Brian Reemtsen and Polimenakos, {Anastasios Charalanpos} and Monica Horn and Winfield Wells",
year = "2008",
month = "7",
day = "1",
doi = "10.1016/j.athoracsur.2008.03.075",
language = "English (US)",
volume = "86",
pages = "198--203",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Role of Clinically Indicated Transbronchial Lung Biopsies in the Management of Pediatric Post-Lung Transplant Patients

AU - Greene, Christina L.

AU - Reemtsen, Brian

AU - Polimenakos, Anastasios Charalanpos

AU - Horn, Monica

AU - Wells, Winfield

PY - 2008/7/1

Y1 - 2008/7/1

N2 - Background: Although transbronchial biopsy (TBB) is the definitive method for diagnosing graft dysfunction after pediatric lung transplantation, concern over procedural complications has limited its use. We reviewed our institutional experience with clinically indicated TBB to determine its safety and efficacy with emphasis on how biopsy findings altered management. Methods: A retrospective chart review was done of 61 pediatric lung transplantation patients undergoing 179 TBB procedures. Data were collected on pre-TBB symptoms, pulmonary function testing, and imaging studies. The prebiopsy diagnosis was noted and compared with the findings from TBB to see how frequently treatment changed after biopsy. Results: Age at TBB ranged from 2 months to 20 years, with an average of 3 biopsies per patient. There was no procedure-related mortality. The incidence of complications was 9% and included important bleeding with spontaneous resolution in 6% and pneumothorax in 3%. The usual indication for TBB was a change in the chest roentgenogram, frequently accompanied by a decrease in flows on spirometry. The TBB specimens were adequate for pathologic analysis 92% of the time, and a specific pathologic diagnosis could be made in 54% of cases. The findings from TBB altered the clinical management of the patient 64% of the time. Conclusions: In pediatric lung transplant recipients presenting with graft dysfunction, TBB is a low-risk diagnostic procedure that yields clinically useful information in a majority of cases. In our experience, the findings from TBB altered medical treatment in 64% of patients. Treatment was most often changed in the group diagnosed with rejection as the probable cause of graft dysfunction.

AB - Background: Although transbronchial biopsy (TBB) is the definitive method for diagnosing graft dysfunction after pediatric lung transplantation, concern over procedural complications has limited its use. We reviewed our institutional experience with clinically indicated TBB to determine its safety and efficacy with emphasis on how biopsy findings altered management. Methods: A retrospective chart review was done of 61 pediatric lung transplantation patients undergoing 179 TBB procedures. Data were collected on pre-TBB symptoms, pulmonary function testing, and imaging studies. The prebiopsy diagnosis was noted and compared with the findings from TBB to see how frequently treatment changed after biopsy. Results: Age at TBB ranged from 2 months to 20 years, with an average of 3 biopsies per patient. There was no procedure-related mortality. The incidence of complications was 9% and included important bleeding with spontaneous resolution in 6% and pneumothorax in 3%. The usual indication for TBB was a change in the chest roentgenogram, frequently accompanied by a decrease in flows on spirometry. The TBB specimens were adequate for pathologic analysis 92% of the time, and a specific pathologic diagnosis could be made in 54% of cases. The findings from TBB altered the clinical management of the patient 64% of the time. Conclusions: In pediatric lung transplant recipients presenting with graft dysfunction, TBB is a low-risk diagnostic procedure that yields clinically useful information in a majority of cases. In our experience, the findings from TBB altered medical treatment in 64% of patients. Treatment was most often changed in the group diagnosed with rejection as the probable cause of graft dysfunction.

UR - http://www.scopus.com/inward/record.url?scp=47049110667&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=47049110667&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2008.03.075

DO - 10.1016/j.athoracsur.2008.03.075

M3 - Article

VL - 86

SP - 198

EP - 203

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -