Surveillance bronchoscopy in children during the first year after lung transplantation: is it worth it?

Benden, Christian; Harpur-Sinclair, O; Ranasinghe, Aruna; Hartley, John C.; Elliott, Martin J.; Aurora, Paul

doi:10.1136/thx.2006.063404

Cited by 31 publications

(35 citation statements)

References 21 publications

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“…Post-transplantation bronchoscopy and surveillance associated morbidity was extremely low and had a high detection rate of asymptomatic acute vascular rejection similar to that recently reported 30. Many of these rejection episodes were asymptomatic and not associated with an obvious fall in lung function.…”

Section: Discussionsupporting

confidence: 74%

Outcomes of lung transplantation for cystic fibrosis in a large UK cohort

Meachery

Soyza²,

Nicholson³

et al. 2008

Thorax

111

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Background: Lung transplantation is an important option to treat patients with advanced cystic fibrosis (CF) lung disease. The outcomes of a large UK cohort of CF lung transplantation recipients is reported. Methods: Retrospective review of case notes and transplantation databases. Results: 176 patients with CF underwent lung transplantation at our centre. The majority (168) had bilateral sequential lung transplantation. Median age at transplantation was 26 years. Diabetes was common pretransplantation (40%). Polymicrobial infection was common in individual recipients. A diverse range of pathogens were encountered, including the Burkholderia cepacia complex (BCC). The bronchial anastomotic complication rate was 2%. Pulmonary function (forced expiratory volume in 1 s % predicted) improved from a pretransplantation median of 0.8 l (21% predicted) to 2.95 l (78% predicted) at 1 year following transplantation. We noted an acute rejection rate of 41% within the first month. Our survival values were 82% survival at 1 year, 70% at 3 years, 62% at 5 years and 51% at 10 years. Patients with BCC infection had poorer outcomes and represented the majority of those who had a septic death. Data are presented on those free from these infections. Bronchiolitis obliterans syndrome (BOS) and sepsis were common causes of death. Freedom from BOS was 74% at 5 years and 38% at 10 years. Biochemical evidence of renal dysfunction was common although renal replacement was infrequently required (,5%). Conclusion: Lung transplantation is an important therapeutic option in patients with CF even in those with more complex microbiology. Good functional outcomes are noted although transplantation associated morbidities accrue with time.

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Section: Discussionsupporting

confidence: 74%

Outcomes of lung transplantation for cystic fibrosis in a large UK cohort

Meachery

Soyza²,

Nicholson³

et al. 2008

Thorax

111

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“…In another study in adults, McWilliams and colleagues suggest ceasing the surveillance bronchoscopy TBBx at 1 year post‐LTx, but continuing annual surveillance bronchoscopy with bronchoalveolar lavage (BAL) beyond that, noting a late 9% pickup of silent infection/colonization particularly with CMV and aspergillus . In a further more recent study by Benden et al acute cellular rejection (≥A2) or subclinical infection was reported at 4% and 29%, respectively, in specimens taken from asymptomatic pediatric patients during the first post‐LTx year . Notwithstanding these reports, there has been a single, again relatively recent, adult study where surveillance bronchoscopy did not find any ≥A2 rejection .…”

Section: Indications For Bronchoscopy In Pediatric Ltxmentioning

confidence: 99%

“…Glanville and colleagues similarly report that the severity of lymphocytic bronchiolitis was a major risk factor for BOS and death . In the pediatric study reported by Benden, nine of 23 patients were reported to have ≥B1 rejection . However, these patients were not treated and unfortunately, no further detail on follow up was reported.…”

Section: Indications For Bronchoscopy In Pediatric Ltxmentioning

confidence: 99%

“…Over sedation and/or oxygen desaturation have not been consistently reported by investigators, however in five adult LTx studies these complications were recognized in up to 7.4% of cases (Table ). None of the pediatric LTx studies specifically report these complications specifically, although in one study a patient was reported to have aspirated during recovery …”

Section: Complications Of Bronchoscopymentioning

confidence: 99%

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Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients

2015

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Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting.

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“…There was no difference in rates of acute rejection between the different sized forceps when TBB was clinically indicated. Another study of 95 surveillance TBBs in children (aged 4.9-17.3 years at time of transplant) found treatable acute rejection in 4% of asymptomatic children and in 12% of those with symptoms [42]. 11 (12%) of the procedures recovered an inadequate amount of tissue to grade for rejection.…”

Section: Transbronchial and Endobronchial Biopsymentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

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Surveillance bronchoscopy in children during the first year after lung transplantation: is it worth it?

Cited by 31 publications

References 21 publications

Outcomes of lung transplantation for cystic fibrosis in a large UK cohort

Outcomes of lung transplantation for cystic fibrosis in a large UK cohort

Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients

ERS statement: interventional bronchoscopy in children

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