Unilateral vs Bilateral Lower Lobe Surveillance Transbronchial Biopsies in Patients with Bilateral Lung Transplant Patients

Abstract

<h3>Purpose</h3> Transbronchial biopsies are routinely performed in surveillance of subclinical rejection after lung transplantation. Sensitivity of transbronchial biopsies can be increased by sampling lower lobes and multiple lobes. Due to the inherent risks of the procedure, biopsies are usually limited to one lung. It is not known if sampling bilateral lower lobes improves diagnostic sensitivity for ACR or affects the outcomes. At our institution, one of the transplant pulmonologist routinely biopsies both the lower lobes hence, this provided us with an opportunity to study and compare the diagnostic yield of biopsies of unilateral vs bilateral lower lobes. <h3>Methods</h3> Retrospective analysis of charts was performed on 83 patients transplanted with lungs bilaterally over 3.5 years. Details of surveillance transbronchial biopsies at 1, 3, 6, 9 (Optional) and 12 months after transplantation were collected for analysis. <h3>Results</h3> 83 lung transplant recipients studied over 3.5 years with a total of 427 transbronchial biopsies. Out of these, 116 procedures were performed bilaterally and 195 procedures were performed unilaterally. Among the 116 patients biopsied bilaterally, 2 samples were inadequate and 25 patients (21.73%) had evidence of ACR including minimal (A1) in 31 samples and A2 rejection in 1 sample. Only 6 out of 25 patients had evidence of ACR in both the lower lobes and 4 out of those procedures were performed in the same patient at different times. Only one of these patient with A2 rejection and another with persistent A1 rejection were treated with pulsed dose steroids for ACR. Among the 195 samples obtained unilaterally, 1 sample was inadequate and 30 biopsy specimens had evidence of ACR (15.38%) including minimal (A1) ACR in 24 samples and mild (A2) rejection in 6 samples. All patients with A2 rejection were treated with pulsed dose steroids for ACR. There were no reported episodes of life threatening hemoptysis or pneumothorax associated any of the above procedures. <h3>Conclusion</h3> In bilateral lung transplant recipients, bilateral lower lobe surveillance transbronchial biopsies may increase the yield for detection of ACR. Detection of ACR simultaneously in both the lower lobes is rare. Unilateral ACR was minimal in most of the biopsies and did not alter the management. Bilateral lower lobe biopsies was not associated with increased risk of pneumothorax