Annual Surveillance Biopsies for Detection of Acute Cellular Rejection Have Limited Utility More Than Two Years Post-Transplant

Abstract

<h3>Purpose</h3> Purpose: Surveillance bronchoscopy for the diagnosis of subclinical rejection are common after lung transplantation. Our center previously performed annual surveillance bronchoscopy with transbronchial biopsy for up to 5 years post-transplant. The goal of this study was to determine the utility of annual surveillance bronchoscopy. <h3>Methods</h3> Medical records were reviewed for patients who underwent lung transplantation between 1/1/2014 and 12/31/2017, survived greater than 1 year, and underwent at least 2 annual bronchoscopy procedures (n=80). Pathology reports for acute cellular rejection were reviewed. Clinical notes and pulmonary function tests were reviewed to determine whether detected rejection was associated with clinical symptoms or a decline in FEV1. <h3>Results</h3> A total of 232 annual surveillance bronchoscopies were performed in 80 patients. 21/232 (9%) of annual bronchoscopies showed A grade rejection and 7/232 (3%) of bronchoscopies showed B grade rejection. Acute cellular rejection (A or B grade) was diagnosed in 22/80 (27.5%) of patients on at least 1 annual procedure. A2 rejection was detected on 8 annual bronchoscopies. A2 rejections occurring after the 2^nd annual bronchoscopy were associated with >10% decline in FEV1 and were clinically apparent, whereas A2 rejections within 2 years of transplant were not. <h3>Conclusion</h3> Conclusion: Annual surveillance bronchoscopy beyond 2 years after lung transplantation has limited clinical utility. After 2 years, significant acute cellular rejection (A2 or greater) was associated with a decline in FEV1.