Significance of surveillance biopsy after lung transplantation – a single center experience

Lung transplantation offers a unique therapeutic option to patients with end-stage lung diseases leading to prolonged life expectancy and better quality of life. Success of lung transplantation is limited by infectious complications and rejection episodes. Prescheduled surveillance bronchoscopies might allow early detection of these complications and thereby influencing therapeutic decisions by timely interventions.

To investigate the impact of surveillance bronchoscopies on therapy we performed a retrospective analysis of 110 patients being lung-transplanted at the University Hospital Freiburg from 2003 till 2013. 400 bronchoscopies were available and analyzed for cytological, microbiological, virological and histological data.

205 bronchoscopies showed 283 pathological results with positive microbiological results (n = 121, 42%) representing the major part of all pathological findings.

81 pathological results (20% of total bronchoscopies) lead to change of clinical management. Histological findings changed therapeutic management in 50% of cases, whereas microbiological and virological findings resulted only in therapeutic measure in 30% and 19% of cases, respectively.

Interestingly, analyses of the cellular distribution of bronchoalveolar lavage demonstrated that the likelihood of a biopsy-proven transplant rejection is increased in individuals that exhibit an increased percentage of lymphocytes and eosinophils in differential cell count.

Survival analysis of the cohort demonstrates a comparable survival after lung transplantation.

In conclusion 20% of surveillance bronchoscopies had a therapeutic impact and differential cell analysis might confer information on the likelihood of transplant rejection.