Surveillance bronchoscopy in cystic fibrosis transplanted patients is safe and effective

Abstract

<b>Introduction:</b> Acute cellular rejection (ACR) and infection are significant causes of morbidity and mortality in transplanted recipients. The use of scheduled post-transplant biopsies (SPB) remains controversial because of its risk-benefit ratio compared to biopsies on clinical demand. Cystic fibrosis (CF) recipients have a higher risk of early immunological complications (ACR and antibody mediated rejection) compared to other diseases. Few studies have evaluated the effectiveness and safety of SPB in CF, with special regard to the time period elapsed from lung transplantation (LTx). <b>Aim:</b> To investigate the incidence of ACR and microbial infection in CF recipients, the safety and adequacy of SPB in detecting ACR and whether the time after LTx may influence these results. <b>Methods:</b> A single-centre retrospective analysis was performed on CF patients who underwent SPB for LTx between January 2019 and December 2020. The time after LTx was recorded in each patient. <b>Results:</b> 92 SPB were performed with a median time after LTx of 24 months (range 1-148). 89(97%) had adequate samples, and ACR was diagnosed in 13 procedures (11%). 3(3.2%) pneumothorax and 3(3.2%) major bleeding were reported. ACR and complication incidence were similar when considering the different time period elapsed from LTx (0-1, 1-2, 2-3, 3-4 and &gt;4 years). CF transplanted from &gt;2 years had a significantly higher number of ACR that required treatment [8/8(100%) vs 2/5(46%), p=0.03] and a lower incidence of infections [5/46(11%) vs 14/46(30%), p=0.03] than those transplanted &lt;2 years. <b>Conclusions:</b> In CF recipients, SPB is a safe and accurate procedure to identify ACR that should be routinely performed in transplant recipient follow-up.