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

Abstract

Background: The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates.Methods: This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality. Results: From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality. Conclusions: OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…Complications were frequent (28.7% of OLBs) and associated with higher mortality rate. 105 A similar study comparing SOT and non-SOT patients with diffuse lung disease demonstrated a therapeutic management change frequency of 33%. 106 Percutaneous CT-guided lung biopsy has been evaluated in one series of SOT recipients with parenchymal lung nodule(s).…”

“…Open lung biopsy (OLB) was studied in a singlecenter kidney transplant population with bilateral lung infiltrates. 105 The overall OLB diagnostic yield was 85.1% with findings from 53% of OLBs resulting in a therapeutic management change. Complications were frequent (28.7% of OLBs) and associated with higher mortality rate.…”

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…Complications were frequent (28.7% of OLBs) and associated with higher mortality rate. 105 A similar study comparing SOT and non-SOT patients with diffuse lung disease demonstrated a therapeutic management change frequency of 33%. 106 Percutaneous CT-guided lung biopsy has been evaluated in one series of SOT recipients with parenchymal lung nodule(s).…”

“…Open lung biopsy (OLB) was studied in a singlecenter kidney transplant population with bilateral lung infiltrates. 105 The overall OLB diagnostic yield was 85.1% with findings from 53% of OLBs resulting in a therapeutic management change. Complications were frequent (28.7% of OLBs) and associated with higher mortality rate.…”

Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit

“…The mortality rate ranges from 10.6% to 66.6% in studies with renal transplant recipients requiring ICU care. 9,13,23,25,[29][30][31] This wide range can be explained by differences in ICU admission criteria and the high heterogeneity among patients, as the time frame from the transplant to ICU admission and the use of immunosuppressive agents are variable. Another potential explanation is the difference among the studies, some of them being single-center studies with a small number of patients.…”

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

“…8,[16][17][18][19] Regarding the causes of ARF, the largest case series on the subject, a retrospective study involving 9 French centers specifically evaluating patients with ARF, showed bacterial pneumonia as the main cause (35.5%), followed by cardiogenic pulmonary edema (24, 5%). 8 In another smaller series from Turkey, also involving renal transplant patients with ARF, but at an earlier time after renal transplantation, the results were similar: bacterial pneumonia (56%) and cardiogenic pulmonary edema (44%).…”

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…Complications were frequent (28.7% of OLBs) and associated with higher mortality rate. 105 A similar study comparing SOT and non-SOT patients with diffuse lung disease demonstrated a therapeutic management change frequency of 33%. 106 Percutaneous CT-guided lung biopsy has been evaluated in one series of SOT recipients with parenchymal lung nodule(s).…”

“…Open lung biopsy (OLB) was studied in a singlecenter kidney transplant population with bilateral lung infiltrates. 105 The overall OLB diagnostic yield was 85.1% with findings from 53% of OLBs resulting in a therapeutic management change. Complications were frequent (28.7% of OLBs) and associated with higher mortality rate.…”

Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit

“…The mortality rate ranges from 10.6% to 66.6% in studies with renal transplant recipients requiring ICU care. 9,13,23,25,[29][30][31] This wide range can be explained by differences in ICU admission criteria and the high heterogeneity among patients, as the time frame from the transplant to ICU admission and the use of immunosuppressive agents are variable. Another potential explanation is the difference among the studies, some of them being single-center studies with a small number of patients.…”

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

“…8,[16][17][18][19] Regarding the causes of ARF, the largest case series on the subject, a retrospective study involving 9 French centers specifically evaluating patients with ARF, showed bacterial pneumonia as the main cause (35.5%), followed by cardiogenic pulmonary edema (24, 5%). 8 In another smaller series from Turkey, also involving renal transplant patients with ARF, but at an earlier time after renal transplantation, the results were similar: bacterial pneumonia (56%) and cardiogenic pulmonary edema (44%).…”

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…Complications were frequent (28.7% of OLBs) and associated with higher mortality rate. 105 A similar study comparing SOT and non-SOT patients with diffuse lung disease demonstrated a therapeutic management change frequency of 33%. 106 Percutaneous CT-guided lung biopsy has been evaluated in one series of SOT recipients with parenchymal lung nodule(s).…”

“…Open lung biopsy (OLB) was studied in a singlecenter kidney transplant population with bilateral lung infiltrates. 105 The overall OLB diagnostic yield was 85.1% with findings from 53% of OLBs resulting in a therapeutic management change. Complications were frequent (28.7% of OLBs) and associated with higher mortality rate.…”

Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit

“…The mortality rate ranges from 10.6% to 66.6% in studies with renal transplant recipients requiring ICU care. 9,13,23,25,[29][30][31] This wide range can be explained by differences in ICU admission criteria and the high heterogeneity among patients, as the time frame from the transplant to ICU admission and the use of immunosuppressive agents are variable. Another potential explanation is the difference among the studies, some of them being single-center studies with a small number of patients.…”

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

“…8,[16][17][18][19] Regarding the causes of ARF, the largest case series on the subject, a retrospective study involving 9 French centers specifically evaluating patients with ARF, showed bacterial pneumonia as the main cause (35.5%), followed by cardiogenic pulmonary edema (24, 5%). 8 In another smaller series from Turkey, also involving renal transplant patients with ARF, but at an earlier time after renal transplantation, the results were similar: bacterial pneumonia (56%) and cardiogenic pulmonary edema (44%).…”