Open Lung Biopsy for Diffuse Disease in Patients With and Without Previously Transplanted Solid Organs

Pulmonary lymphangitic carcinomatosis presenting as severe interstitial lung disease in a 15-year-old female

“…Early in her admission, as it was hoped the patient's condition would improve, an open lung biopsy was thought to carry an unacceptable risk of significant complications or death. This is supported by a recent review which reports the mortality rate of open lung biopsy in mechanically ventilated patients as 54% [7]. With hindsight it can be argued that despite the patient's condition the biopsy should have been performed on day 3 as she had deteriorated further by the time it was performed on day 16.…”

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

“…The diagnostic yield of OLB, which does not specifically address solid organ transplant patients, ranges between 34% and 100% (16,17,19,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). In solid organ transplant patients, Defranchi et al reported that 29% had a change in clinical management as a result of the OLB findings (16).…”

“…We recorded the following data: patient demographics, transplant characteristics, the time frame from symptom onset to the date of the OLB, the simplified acute physiology score 3 (SAPS 3) at ICU admission, the Sequential Organ Failure Assessment (SOFA) score in the 24 hours before the OLB, the main radiological characteristics of the pulmonary lesions on the following day (16,26), and related procedures, such as bronchial lavage or trans-bronchial biopsies. We also analyzed the data regarding complications related to the biopsy, pathologic and microbiologic results, therapeutic changes after the OLB results (the addition or withdrawal of drugs), and ICU and hospital mortality rates.…”

“…However, there are safety concerns related to the procedure (22,23). As some of the available evidence suggests that establishing a diagnosis not necessarily change management or affects clinical outcomes (16,24), the potential benefits of this invasive procedure need to be carefully assessed.…”

“…Lung biopsies with histopathology and microbiology analyses are often needed for a specific diagnosis in transplant recipients (6). An open lung biopsy (OLB) is considered the best diagnostic method for patients with diffuse lung disease (16)(17)(18)(19). In immunosuppressed patients, specific diagnoses can be obtained in up to 80% of cases (20).…”