Abstract
Lung transplantation is a potentially life-saving therapy for patients with terminal respiratory illnesses. Long-term survival is limited by the development of a variety of opportunistic infections and rejection. Optimal means of differential diagnosis of infection and rejection have not been established. With these challenges in mind, we tried to use transbronchial lung biopsy (TBLB) rapid on-site cytological evaluation (ROSE), metagenomic next-generation sequencing (mNGS), and routine histologic examination to timely distinguish infection and rejection, and accurately detect etiologic pathogens. We reviewed the medical records of all patients diagnosed with infection or rejection by these means from December 2017 to September 2018 in our center. We identified seven recipients whose clinical course was complicated by infection or rejection. Three patients were diagnosed with acute rejection, organizing pneumonia, and acute fibrinoid organizing pneumonia, respectively. Four of the seven patients were diagnosed with infections, including Pneumocystis carinii pneumonia, cytomegalovirus, Aspergillus, and bacterial pneumonia. These patients recovered after proper treatment. TBLB + ROSE + mNGS might be a good method to accurately detect etiologic pathogens, which may help us to facilitate the use of targeted and precision medicine therapy in postoperative complications and avoid unnecessary potential adverse effects of drugs.
Highlights
Lung transplantation is a potentially life-saving therapy for patients with terminal respiratory illnesses that are refractory to conventional therapies such as idiopathic pulmonary fibrosis (IPF), emphysema, cystic fibrosis, bronchiectasis, sarcoidosis, pulmonary arterial hypertension, lymphangioleiomyomatosis, and so on [1].The estimated posttransplant long-term survival rate is 50% at 5 years and 27% at 10 years [2], long-term survival is limited by the development of a variety of opportunistic infections, acute allograft rejection, and chronic lung allograft dysfunction [3]
The bronchoalveolar lavage fluid (BALF) sent to the microbiology laboratory to underway Galactomannan antigen detection (GM test), Mycobacterium tuberculosis/rifampicinresistance test (X-pert), and centrifugal sediment of BALF were smeared on slides for gram staining, acid-fast staining, and hexamine silver staining
The final diagnosis of pulmonary infections is confirmed by a comprehensive analysis of clinical manifestation, imaging manifestation, findings of traditional pathogen detection based on respiratory specimens mentioned above, metagenomic next-generation sequencing (mNGS), serological examination, rapid on-site cytological evaluation (ROSE), and histopathology, expert opinion, and treatment effect observations
Summary
Lung transplantation is a potentially life-saving therapy for patients with terminal respiratory illnesses that are refractory to conventional therapies such as idiopathic pulmonary fibrosis (IPF), emphysema, cystic fibrosis, bronchiectasis, sarcoidosis, pulmonary arterial hypertension, lymphangioleiomyomatosis, and so on [1]. Since it is difficult to rule out infectious pulmonary complications by manifestations and CT scan findings, it is often unavoidable to start empiric therapy based on clinical and radiologic findings without a definitive diagnosis by pathological or microbiological findings, which is of uncertain accuracy [5]. This approach can lead to inappropriate treatment with the ensuing risks of possible adverse events, while potentially reversible causes may go unrecognized. We focused on the use of TBLB + ROSE + mNGS for recognition of postoperative complications of lung transplantation
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