Pulmonary infiltrates after heart-lung transplantation: Evaluation by serial transbronchial biopsies

Va, Starnes; Theodore, James; Pe, Oyer; Eb, Stinson; Ce, Moreno-Cabral; Sibley, Richard K.; Barry, G. H.; Ne, Shumway

doi:10.1016/s0022-5223(19)34276-x

Cited by 37 publications

(4 citation statements)

References 13 publications

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“…Even with transbronchial biopsies, bronchoscopy with lavage was only 83% sensitive in establishing a diagnosis of IA in our 30 patients with definite or probable pulmonary IA. These results are comparable to other studies in bone marrow, heart, and lung transplant recipients (15, 16). Serologic testing was negative in all patients tested.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants

Minari

Husni

Avery

et al. 2002

Transplant Infectious Dis

344

151

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Section: Discussionsupporting

confidence: 90%

“…Hypogammaglobulinemia has recently been associated with IA in lung transplant recipients at our institution (13 (15,16). Serologic testing was negative in all patients tested.…”

Section: Discussionmentioning

confidence: 80%

The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants

Minari

Husni

Avery

et al. 2002

Transplant Infectious Dis

344

151

View full text Add to dashboard Cite

show abstract

“…Among solid organ transplant patients with a nonbiopsy, lower respiratory tract culture positive for Aspergillus species, 58% were found to have invasive aspergillosis in one study (56). Even with transbronchial biopsy, BAL is far less than 100% sensitive for invasive aspergillosis, although the sensitivity of BAL is higher for Pneumocystis and viral infections (57, 58). The diagnostic yield for aspergillosis as well as other conditions may sometimes be improved by proceeding to open‐lung biopsy (59–61).…”

Section: Diagnosis Of Aspergillosismentioning

confidence: 99%

Aspergillosis in lung transplantation: incidence, risk factors, and prophylactic strategies

Gordon

Avery

2001

Transplant Infectious Dis

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Invasive aspergillosis remains a significant cause of morbidity and mortality in transplantation, especially lung and allogeneic bone marrow transplant recipients. The epidemiology, classic and newly recognized risk factors, and incidence of aspergillosis are reviewed. Risk factors include environmental exposures, airway colonization, profound immunosuppression, neutropenia, prior cytomegalovirus infection, and renal dysfunction. Clinical and radiographic presentations of invasive aspergillosis are discussed, including some unusual manifestations in lung transplant recipients. Early and accurate diagnosis of aspergillosis remains a challenge, and diagnostic strategies are reviewed, with an emphasis on the chest computerized tomography scan and on transbronchial or open lung biopsy. Recent advances include prophylactic and pre-emptive antifungal strategies, newer therapeutic agents, and improved risk stratification.

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“…In one large adult study, the diagnostic yield for acute cellular rejection, lymphocytic bronchiolitis, or infection was 18.9% in surveillance biopsies and 86.4% in clinically-indicated biopsies [33]. An early study of heart-lung transplant recipients with TBB for pulmonary infiltrates showed a similar high diagnostic yield (72.5%) [35]. In pediatric lung transplant patients, treatable acute cellular rejection has been identified in approximately one-fourth (24%) of routine surveillance TBBs and approximately half (47%) of biopsies performed for clinical symptomatology [36].…”

Section: Diagnostic Specimens and Role Of Pathology Laboratories In Pmentioning

confidence: 99%

Pediatric Lung Transplantation: Perspectives for the Pathologist

Dishop

Mallory²,

White

2008

Pediatr Dev Pathol

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Lung transplantation offers life-saving and life-extending treatment for children and adolescents with congenital and acquired forms of pulmonary and pulmonary vascular disease, for whom medical therapy is ineffective or insufficient for sustained response. This review summarizes the pathology related to lung transplantation for the practicing pediatric pathologist and also highlights aspects of lung transplantation unique to the pediatric population. Clinical issues related to availability of organs, candidate eligibility, surgical technique, and postoperative monitoring are discussed. Pathologic evaluation of routine surveillance transbronchial biopsies requires attention to acute cellular rejection, opportunistic infection, and other forms of acute and resolving lung injury. These findings are correlated in some cases with endobronchial biopsies and bronchoalveolar lavage as adjunctive tools in surveillance. Open or thoracoscopic biopsies also have diagnostic utility in cases with acute or chronic graft deterioration of uncertain etiology. Future challenges in pediatric lung transplantation are similar to those in the adult population, with continued efforts focused on prolonging graft survival, prevention of bronchiolitis obliterans syndrome due to chronic cellular rejection, and evaluation of humoral rejection.

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Pulmonary infiltrates after heart-lung transplantation: Evaluation by serial transbronchial biopsies

Cited by 37 publications

References 13 publications

The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants

The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants

Aspergillosis in lung transplantation: incidence, risk factors, and prophylactic strategies

Pediatric Lung Transplantation: Perspectives for the Pathologist

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