Surveillance Bronchoscopy inLung Transplant Recipients

Study objectives: To establish whether a consensus exists amongactivetransplant centers regarding theuse andinterpretation ofinformation obtained bysurveillance bronchoscopic lung biopsy (SBLB). Design: Prospective standardized questionnaire answered viamailandtelephone communications. Participants: A five page,18-question survey was senttoalllung transplant programs listed bythe United Network ofOrgan Sharing inNorthAmerica, aswell aseight selected international programs. Ninety-one surveys were sentto83North American andeight international programs. Seventy-four programs (81%) responded. Seventeen programs (19%) were excluded secondary toinactivity. The remaining 57programs (63%) were included infinal dataanalysis. Interventions: None. Results: Sixty-eight percent (39/57) oftheresponding programs perform SBLBs.Ninety-two percent oftheprograms performing SBLBsdoso within thefirst month, and69%continue todoso on a regular basis. Sixty-nine percent (27/39) ofprograms performing SBLBscontinue todoso after 1 year.Eighty-six percent (32/37) ofrespondents believe that SBLBimpacts on patient management at least 10%ofthetime.Technically, 90%(35/39) takebiopsy specimens from more than one lobeper SBLBsession. Fifty-nine percent (23/39) took 6to10biopsy specimens persession, 33%(13/39) took three tofivebiopsy specimens, and7%(4/39) took>10biopsy specimens persession. Eighty-six percent (32/37) oftheresponding centersreported treating asymptomatic rejection atgrade 2A, while 14%(5/37) waited until histologic grade 3Abefore beginning treatment. Complications from SBLBwere minimal with 95%oftheprograms performing SBLB. Conclusion: Mostactivelung transplant centersperform SBLBsanddoso on a regular basis. However, awiderange ofopinion exists overtheutility andtechnique ofSBLBandtheimpact ofits results influencing outcomeinthelung transplant recipient. Toanswer these questions, arandomized multicentered trial orregistry todetermine theeffect ofSBLBonlung transplant recipient morbidity andmortality isrequired. (CHEST 1997; 111:377-81)