Diagnostic yield of bronchoalveolar lavage following renal transplantation

Abstract

Organ transplant recipients are at high risk of infectious pulmonary complications. In this retrospective study, the diagnostic yield of bronchoalveolar lavage (BAL) was evaluated in renal transplant recipients. The results were analysed in special regard to the clinical presentation of pulmonary infections and the possible impact of new immunosuppressive agents. Over a 5-year period 91 BAL were performed in 71 renal transplant recipients. Microorganisms were isolated from 69% of BAL (63/91): bacteria 32%; cytomegalovirus (CMV) 27%; Pneumocystis carinii (PC) 22%; other viruses 9% (HSV; EBV, RSV, adenovirus, HHV8); Aspergillus fumigatus 1%. Total cell counts and neutrophil counts in BAL were significantly elevated in bacterial infection, whereas BAL positive for PC showed eosinophilia (P<0.05). There was no association between clinical symptoms and the radiological pattern of infiltrates and the type of infection. Immunosuppression containing tacrolimus or mycophenolate mofetil was associated with a significantly higher percentage of PC and CMV infections compared to cyclosporin-based immunosuppression (65% vs. 30%, P<0.005). A considerable number of PC and CMV infections occurred beyond 6 months after transplantation. In conclusion, BAL has a high diagnostic yield in renal transplant recipients. Infection with CMV and PC should also be considered beyond 6 months after transplantation, and prophylaxis for opportunistic infections should be given if the immunosuppression is intensified.

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis

“…Atypical patterns are often found in patients with diabetes or in renal transplant recipients [30]. However, REICHENBERGER et al [31] have previously reported a very low incidence of TB in immunocompromised patients. Between 42 and 86% of patients with pulmonary TB may be symptomatic [32,33].…”

Role of Bronchoalveolar Lavage in Diagnosis of Fungal Infections in Liver Transplant Recipients

“…This procedure has been used extensively as a diagnostic procedure in transplant recipients with suspected pulmonary infections, especially opportunistic infections. 3,4 Candida and Aspergillus species are the most important causes of invasive fungal infections in solid-organ transplant recipients, and are associated with almost 100% mortality. 1,5 In most studies, the infection started during the first 6 months after transplant.…”

“…11 Similar results were reported in the study of Reichenberger and coworkers, who evaluated the diagnostic yield of BAL in renal transplant recipients; microorganisms were isolated from 69% BAL cases, but most were bacterial and viral, and Aspergillus was detected only in 1 case. 3 Hohenadel and associates 12 investigated the role of BAL in 95 immunocompromised patients who had hematologic disorders with pneumonia. Pathologically relevant isolates were observed in 65% cases; BAL provided the definitive diagnosis in only 29 cases (31%), and 11% of these infections were fungal.12 In a study by Al-Za'abi and coworkers in immunosuppressed patients (96% lung transplant recipients), the most common identified organism was Aspergillus species, and 17% Aspergillus cases were detected by BAL cytologic examination.…”

“…Therefore, rapid diagnosis of fungal infections in immunocompromised patients is important. 3 Bronchoscopy with bronchoalveolar lavage (BAL) is an important tool for the diagnosis of pulmonary infections. This study sought to analyze the effectiveness of BAL in establishing the diagnosis of pulmonary infections in liver transplant recipients.…”

Pneumonien bei Immunsuppression

“…Die diagnostische Ausbeute der Bronchoskopie beträgt in Studien mit immunkompromittierten Patienten unterschiedlicher Provenienz 56 bis 72% [38,39]. Bei neutropenischen Patienten, die zum Zeitpunkt der Untersuchung meist unter einer breiten empirischen Antibiotikatherapie stehen, liegt die Ausbeute niedriger.…”