Bronchial Washings Research Articles

Diagnostic Yield of Fiberoptic Bronchoscopy Washings among Patients of Sputum Smear Negative Pulmonary Tuberculosis

Fiberoptic bronchoscopy with bronchial washing is done for diagnosis of pulmonary tuberculosis among patients who cannot produce sputum spontaneously. Aim: To evaluate the diagnostic yield of Fiberoptic Bronchoscopy for detection of positive cases in cases of Smear negative pulmonary tuberculosis. Study Design: Cross-sectional study. Methodology: All patients (n=80) were advised NPO for 6 hours before carrying out the procedure. It was done using local anesthesia while retrievement of the instilled amount by 25% was considered successful. The bronchial washings were sent for AFB staining in-order to confirm the presence or absence of Mycobacterium Tuberculosis. Bronchial washing smear was considered positive if 1-9 AFB/HPF are seen on direct microscopy. Statistical Analysis: SPSS v.26 analyzed the data. Stratification of diagnostic yield was done with respect to age and gender. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: The diagnostic yield of FOB for detection of positive cases in cases of Smear negative PTB was 57.5%. The highest diagnostic yield was seen in patients in the age group 16-32 and 49-60 years old patients i.e. 37% in both groups. For both genders diagnostic yield for FOB was 50%. However patient’s age and gender were insignificantly associated with diagnostic yield of FOB. Conclusion: It was concluded that FOB can provide a rapid and definitive diagnosis of pulmonary tuberculosis in sputum negative patients. Keywords: Diagnostic Yield, Fiberoptic Bronchoscopy, Smear Negative and Pulmonary Tuberculosis.

Current status of cytopathology practice in Korea: impact of the coronavirus pandemic on cytopathology practice.

The Continuous Quality Improvement program for cytopathology in 2020 was completed during the coronavirus pandemic. In this study, we report the result of the quality improvement program. Data related to cytopathology practice from each institute were collected and processed at the web-based portal. The proficiency test was conducted using glass slides and whole-slide images (WSIs). Evaluation of the adequacy of gynecology (GYN) slides from each institution and submission of case glass slides and WSIs for the next quality improvement program were performed. A total of 214 institutions participated in the annual cytopathology survey in 2020. The number of entire cytopathology specimens was 8,220,650, a reduction of 19.0% from the 10,111,755 specimens evaluated in 2019. Notably, the number of respiratory cytopathology specimens, including sputum and bronchial washing/ brushing significantly decreased by 86.9% from 2019, which could be attributed to the global pandemic of coronavirus disease. The ratio of cases with atypical squamous cells to squamous intraepithelial lesions was 4.10. All participating institutions passed the proficiency test and the evaluation of adequacy of GYN slides. Through the Continuous Quality Improvement program, the effect of coronavirus disease 2019 pandemic, manifesting with a reduction in the number of cytologic examinations, especially in respiratory-related specimen has been identified. The Continuous Quality Improvement Program of the Korean Society for Cytopathology can serve as the gold standard to evaluate the current status of cytopathology practice in Korea.

Utility of cell-free DNA from bronchial washing fluid in diagnosis and genomic determination for radiology-suspected pulmonary nodules.

Bronchial washing fluid (BWF) is a less-invasive specimen. Due to the limited sensitivity of BWF cellular component diagnosis, the aim of this study was to explore the potential role of BWF supernatant as a source of liquid biopsy of lung cancer. This prospective study enrolled 76 suspected and 5 progressed lung cancer patients. Transbronchial biopsy tissues, BWF supernatant (BWF_Sup) and BWF precipitant (BWF_Pre) were tested by a targeted panel of 1021 genes. BWF_Sup cell-free DNA (cfDNA) was superior to tissue biopsy and BWF_Pre in determining mutational allele frequency, tumour mutational burden, and chromosomal instability. Moreover, BWF_Sup and BWF_Pre achieved comparable efficacy to tissue samples in differentiating malignant and benign patients, but only BWF_Sup persisted differentiated performance after excluding 55 malignancies pathologically diagnosed by bronchoscopic biopsy. Among 67 malignant patients, 82.1% and 71.6% of tumour-derived mutations (TDMs) were detected in BWF_Sup and BWF_Pre, respectively, and the detectability of TDMs in BWF_Sup was independent of the cytological examination of BWF. BWF_Sup outperformed BWF_Pre in providing more subclonal information and thus might yield advantage in tracking drug-resistant markers. BWF_Sup cfDNA is a reliable medium for lung cancer diagnosis and genomic profiles and may provide important information for subsequent therapeutic regimens.

BACTERIAL TRACHEITIS IN A PATIENT AFTER INTUBATION

BACTERIAL TRACHEITIS IN A PATIENT AFTER INTUBATION

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study.

Background: Since December 2019, SARS-CoV-2 has been causing cases of severe pneumonia in China and has spread all over the world, putting great pressure on health systems. Nasopharyngeal swab (NPS) sensitivity is suboptimal. When the SARS-CoV-2 infection is suspected despite negative NPSs, other tests may help to rule out the infection. Objectives: To evaluate the yield of the lower respiratory tract (LRT) isolation of SARS-CoV-2. To evaluate the correlations between SARS-CoV-2 detection and clinical symptoms, and laboratory values and RSNA CT review scores in suspect patients after two negative NPSs. To assess the safety of bronchoscopy in this scenario. Method: A retrospective analysis of data from LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after two negative NPS. Chest CT scans were reviewed by two radiologists using the RSNA imaging classification. Results: SARS-CoV-2 was detected in 14/99 patients (14.1%). A correlation was found between SARS-CoV2 detection on the LRT and the presence of a cough as well as with typical CT features. Typical CT resulted in 57.1% sensitivity, 80.8% accuracy and 92.3% NPV. Neither severe complications nor infections in the personnel were reported. Conclusions: In suspect cases after two negative swabs, CT scan revision can help to rule out COVID-19. In selected cases, with consistent CT features above all, LRT sampling can be of help in confirming COVID-19.

DIAGNOSTIC YIELD OF FIBEROPTIC BRONCHOSCOPY IN A TERTIARY CENTER

Background: Fiberoptic Bronchoscopy is a valuable tool in current respiratory medicine. This study was aimed to evaluate the diagnostic yield of Fiberoptic Bronchoscopy using a wider diameter bronchoscope. Methods: This was a hospital based cross-sectional study carried out in BP Koirala Memorial Cancer Hospital from January 2021 to March 2021. Consecutive sampling technique was used where 150 patients were enrolled in the study. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statistics. Results: The overall yield from the wider Fiberoptic Bronchoscope was 70.07% which was slightly higher compared to literature results from conventional bronchoscopy. Lung mass on CT scan was the most common indication for bronchoscopy and upper lobe bronchus was the most common site for biopsy. Bronchial wash yield was highest for Squamous cell carcinoma with 22.78% followed by Pulmonary Tuberculosis with 21.5%. Endobronchial biopsy yield was highest for Squamous cell carcinoma with 41.21% followed by Adenocarcinoma with 31.42%. Temporary hypoxia and mild bleeding were common but life-threatening complications were rare. Conclusions: Overall findings of our study confirm that the diagnostic yield of Fiberoptic Bronchoscopy is high, particularly when a larger diameter bronchoscope is used which can facilitate wider biopsy forceps for larger tissue sampling.

Bronchial Washing Using a Thin Versus a Thick Bronchoscope to Diagnose Pulmonary Tuberculosis: A Randomized Trial.

This study was performed to evaluate the efficacy of using a thin bronchoscope for the diagnosis of pulmonary tuberculosis (PTB). Between March 2019 and November 2021, we prospectively enrolled participants with suspected PTB whose sputum acid-fast bacilli (AFB) smear and tuberculosis (TB) polymerase chain reaction (PCR) tests were negative or who could not produce self-expectorated sputum. Participants were randomized to a control group (bronchial washing [BW] using a 5.9-mm conventional bronchoscope guided by chest computed tomography) or an investigational group (BW using a 4.0-mm thin bronchoscope under virtual bronchoscopic navigation guidance). The primary outcome was detection of TB in BW fluid, defined as a positive result in the Xpert MTB/RIF assay. The secondary outcomes included AFB smear and Mycobacterium tuberculosis culture positivity, time to treatment initiation, and bronchoscopy-related complications. In total, 85 participants were included in the final analysis (43 in the control group and 42 in the investigational group). Twenty-three and 29, respectively, were finally diagnosed with PTB. The TB detection rate in BW fluid was higher in the investigational group (72.4% vs 43.5%, P = .035). Mycobacterium tuberculosis culture positivity was also higher in the investigational group (79.3% vs 52.2%, P = .038). No participants required premature bronchoscopy termination because of complications. Of the participants with PTB, the time to treatment initiation was shorter in the investigational group (median, 2.0 days vs 4.0 days, P = .001). BW using a thin bronchoscope increases the TB detection rate in patients with PTB compared to conventional bronchoscopy. Clinical Trials Registration.ȃNCT03802812.

P455 Identification of Cryptic species of Aspergillus using Beta-tubulin gene in a tertiary care center in South India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesTo identify cryptic species of the genus Aspergillus using Beta-tubulin gene by sequence typing.Methods Aspergillus grown from various clinical samples (Ear swab, Bronchial wash, Endotracheal Aspiration, Paranasal sinus, BAL, Sputum) was subcultured on Sabouraud's Dextrose Agar/Oatmeal Agar.Tease mount/Slide culture was done to study the morphological features of the hyphae, size, shape, and arrangement of the conidia.DNA Extraction using phenol-chloroform method: DNA was extracted and purified directly from 4-day-old culture and used as a template for polymerase chain reaction (PCR) amplification.DNA Amplification: A fragment of the target gene were amplified using PCR.The primer pairs used for Beta-tubulin gene was Bt2a (Forward primer) and Bt2b (Reverse primer).Beta-tubulin.Bt2a FGGTAACCAAATCGGTGCTGCTTTCBt2b RACCCTCAGTGTAGTGACCCTTGGCDNA Purification: The PCR product was purified with multi-screen filter plates.Gel electrophoresis: The amplified DNA product was subjected to agarose gel electrophoresis and specific band formation was to be observed for the species of Aspergillus.DNA Sequencing: The purified product will be used as a template for sequencing. An applied biosystem 3730 sequencer will be used to obtain DNA sequences.Phylogenetic Analysis: Parsimony analysis of individual and combined matrices will be conducted using PAUP version 4.0b10 software/free software at phylogeny.fr by the maximum parsimony (MP) and Neighbor-joining methods.The results will be represented using a dendrogram.ResultsA total of 30 Aspergillus isolates were collected and identified using Phenotypic methods.The DNA extraction and PCR amplification were done and sent for Sequencing. The results of Sequence typing are awaited.ConclusionCryptic species are morphologically indistinguishable forms of Aspergillus and their identifications can be confirmed exclusively by using molecular techniques which have led to the description of previously unknown or rare species among different Aspergillus species complex. According to studies, the frequency of such species was found to be 10% in TRANSNET study U.S and 12% in FILPOP study Spain. Most of these species are less susceptible and certain species are multidrug-resistant (azoles and amphotericin B) and the emergence of antifungal-resistance among the Aspergillus species forms the importance in identifying Cryptic species.

DNA aneuploidy combined with radial EBUS in the diagnosis of peripheral lung lesions.

To explore the diagnostic value of DNA aneuploidy analysis combined with radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy in peripheral lung lesions. We performed a retrospective analysis of patients who underwent R-EBUS examination. DNA aneuploidy analysis of bronchial washing from the target bronchial segment were performed. The clinical information, R-EBUS data, pathological results and DNA image cytometry (DNA-ICM) results were collected. For patients who did not have a clear diagnosis after bronchoscopy, follow-up data was recorded. A total of 42 cases were included. Thirty patients had confirmed malignant tumor of the lung, 19 of which were confirmed by pathology after bronchoscopy, and 11 cases were confirmed later by surgery or percutaneous lung puncture. Twelve patients were finally considered to have benign lesions. The sensitivity of R-EBUS is 63.3% and the specificity is 100%. DNA-ICM has a sensitivity of 76.7% and a specificity of 91.7%. When combined, they have a sensitivity of 90%, and specificity 91.7%. As for malignant lesions, we further analyzed smoking, the size and location of lesions on chest CT, the number of aneuploid cells and the maximum value of DNA content. The results indicated that increased number of aneuploid cells or increased max value of DNA content may predict higher probability of malignancy. DNA-ICM combined with R-EBUS can improve the diagnostic sensitivity of malignant peripheral lung lesions. Increased number of aneuploid cells or increased max value of DNA content may indicate that the lesions are more likely to be malignant.

Pulmonary Actinomycosis and Multiple Cavitary Lung Lesions in a Patient Previously Reported with Pulmonary Candidiasis: A Case Report

This paper presents the case of a 43 years old patient admitted three times to the Pneumology Department with productive cough, asthenia,
 important weight loss, and fever. His chest CT showed multiple pulmonary cavities growing over time, ground-glass opacities, and pleural effusion. Clinical symptoms and radiological signs were highly suggestive of tuberculosis, but he tested negative multiple times. Candida spp. was diagnosed through bronchial washing and treated. After a few months, the patient comes back with worsened symptoms and is diagnosed with pulmonary actinomycosis.

Morphology quiz: Bronchial washing cytology from flexible bronchoscopy.

The aim of this observation is to aware cytologists on melanoma cells identification in bronchial washing, from an endobronchial metastasis of malignant melanoma. Images of CT scan and flexible bronchoscopy are also provided. Differential diagnosis and additional analyses (molecular biology) are also mentioned and discussed.

Antibiotics susceptibility against Pseudomonas aeruginosa isolated from different infections

In the present study, a total 70 samples were collected from different sites of infection which include 25(35.7%) samples from bronchial wash, 15 (21.4%) samples from urine, 15 (21.4%) samples from ear swabs, and 15 (21.4%) samples wound swabs), these samples have been collected and tested during period from March 2022 to June 2022. The results showed that, out of 70 samples, 62(88.5%) give positive culture, while 8(11.5%) samples were negative culture. Out of 62 positive culture on different types of growth media, and the bacterial was identified according to gram stain, biochemical tests and Vitek compact system, the results showed that, only 18(29.1%) isolates were related to Pseudomonas aeruginosa, while 44 (70.9%) samples were related to other types of microbial agents, these isolates which include 5/18(28%) isolates from bronchial wash, 4/18(22.1%) isolates from urine, 2/18(11.1%) isolates from ear swabs and 7/18(38.8%) isolates from wound swabs. To confirm the isolates of bacteria was used automated Compact Vitek-2 system use GN-ID cards which contained 64 biochemical tests.

Role of Fiberoptic Bronchoscopy and Utility of Bronchial Washings and Brushings in the Diagnosis of Lung Diseases

Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken. Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

Spectrum of Intrabronchial Mass Lesions and Role of Flexible Bronchoscopy in Their Diagnosis: A Series of 74 Cases

Variety of benign and malignant lesions of respiratory system presents as intrabronchial mass lesions. Present study was carried out to study the spectrum of intrabronchial lesions and role of flexible flexible bronchoscopy in their diagnosis. Retrospective study of case-records of patients with intrabronchial mass lesions diagnosed by flexible bronchoscopy, bronchial washings and bronchial biopsy between January 2004 and June 2006. Out of the 696 flexible bronchoscopies done during the study period, intrabronchial mass lesions were evident in 74 patients (10.6%) (age range 21-86 years; 60 males). Fifty (68%) lesions were malignant, eighteen (24%) lesions were benign while six (8%) lesions were inconclusive. Diagnostic yield was about 92%; repeat bronchoscopy for inconclusive results improved the diagnostic yield. Though malignant lesions are common, benign lesions remain important causes of intrabronchial mass lesions. Bronchoscopy with adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

Prognostic impact of preoperative respiratory colonization on early-onset pneumonia after lung transplantation.

BackgroundThe number of lung transplantation procedures is rapidly increasing worldwide. Little is known about the effect of perioperative respiratory microbial colonization on pneumonia during lung transplantation. We evaluated the microbiome composition and incidence of early pneumonia in patients undergoing lung transplantation. We investigated factors related to post-transplant pneumonia (PTP) after lung transplantation.MethodsA retrospective analysis of patients subjected to lung transplantation between May 2013 and December 2019 was performed. Perioperative microbial colonization, and its relationship with early pneumonia, were examined in specimens from bronchial washing, bronchoalveolar lavage, and sputum aspiration before and after surgery. One-year mortality, as the primary outcome, was analyzed using the Kaplan-Meier curve model.ResultsAmong 76 patients who underwent lung transplantation, 34 donors (44.7%) and 28 recipients (36.8%) showed positive respiratory cultures with respect to preoperative respiratory colonization. A separate analysis of donors and recipients showed that 42 donors and 48 recipients were in respiratory non-colonized state, and 28 (53.8%) donors and 36 (69.2%) recipients survived 1 year after lung transplantation. Acinectobacter baumannii was the most common respiratory multidrug-resistant (MDR) pathogen. PTP was significantly lower in the survivor group (38.5% vs. 70.8%, P=0.009). Out of the recipients with preoperative respiratory colonization, 57.1% survived 1 year after lung transplantation. Patients with PTP had significantly higher 1-year mortality than those without PTP (P=0.009). Preoperative respiratory colonization of the recipients (P=0.010) and PTP patients (P=0.005) was associated with high 1-year mortality rate. Perioperative respiratory colonization of donors was not associated with the incidence of PTP and 1-year survival.ConclusionsPerioperative colonization of recipients was a powerful predictive factor for PTP, which was associated with 1-year mortality in patients subjected to lung transplantation. Our results suggest that donor acceptance criteria may change to better address potential shortages in organ donation.

HYPOXEMIA AND LUNG MECHANICS DURING FIBEROPTIC BRONCHOSCOPY

Background: Arterial hypoxaemia is the common complication, since respiratory depressant drugs are used for premedication, and the airway is also partially occluded by the bronchoscope. The study is therefore designed to nd out the changes in arterial oxygen tension and PFTduring FOB. Objectives: To nd out the changes in arterial oxygen tension and pulmonary function tests during FOB. Methods: One hundred patients aged 20 years above undergoing FOB were evaluated for the arterial oxygen tension and pulmonary function tests changes at KNCH, Jodhpur. Results: All patients developed a fall in PaO2 following FOB but hypoxemia was noted only in 18 cases. Bronchial washing, punch biopsy and brush biopsy did contribute to hypoxemia signicantly. The pulmonary functions which include change in V.C, FVC, FEV1 and PEFR after FOB, no statistical difference could be observed on statistically comparison. Conclusion: All patients showed a decline in arterial PaO2 after FOB which was highly signicant. FOB itself does not cause any signicant or serious complications.

Autopsy study of fatal invasive pulmonary aspergillosis: Often undiagnosed premortem

Invasive aspergillosis (IA) is a serious complication in immunocompromised and critically ill patients but is difficult to diagnose. We sought to examine how often cases go undiagnosed and to understand the presenting clinical and radiologic features associated with fatal IA. We reviewed cases of fatal IA confirmed at autopsy (N = 67) between 1999 and 2019 at a tertiary academic hospital. At autopsy, pulmonary involvement was present in 97% of cases--46% were limited to the lungs and 51% had concomitant extrapulmonary involvement. Immunosuppression with either glucocorticoids and/or other immunosuppressive agents was present in 85%. Among those not immunocompromised (15%), chronic lung disease was present in 70%, and a respiratory coinfection was found in 50%. Chest imaging abnormalities including consolidation, ground glass opacities, halo sign, cavitation, and air crescent sign were present in 49%, 49%, 37%, 22%, and 7% of cases, respectively. Diagnostic bronchoscopy was performed in 61% of cases and yielded aspergillus in 63% of those cases by either bronchoalveolar lavage (galactomannan and/or culture), bronchial washings, or transbronchial biopsy cultures. Either a respiratory coinfection or other systemic coinfection was diagnosed in 64%. The performance of diagnostic bronchoscopy was associated with accurate pre-mortem identification of IA (p = 0.001). Clinicians correctly identified IA as the cause of death in only 27% of fatal IA cases identified at autopsy. Complex presenting features, high rates of co-infections, and low rates of invasive diagnostic procedures may have led to missed diagnoses of IA.

Cytologic diagnosis of neuroendocrine neoplasms including carcinoid tumours- A retrospective study

The classification of neuroendocrine neoplasms has evolved substantially over time but remains a topic of controversy and debate. Cytology has become one of the mainstays of diagnosis for these tumors, and the treatment may be entirely based on the FNA report.: This is a retrospective study which aims to describe the cytological features found in different groups of Neuroendocrine neoplasms. We have also tried to enumerate the not so typical features which we have seen in our cases. Cases of Neuroendocrine neoplasms diagnosed by cytology in the year 2018 were included in this study. The slides of these cases were retrieved, cytological features reviewed, and clinicopathological features evaluated. Histopathological correlation was done wherever possible. In this retrospective study, there were 43 cases which included FNA (n=38), Fluid cytology(n=3), Bronchial washings and Brushings(n=2). FNA sites included lung, cervical lymph nodes, scalp, liver, pancreas, and mesentery with the cytological diagnoses of Small cell carcinoma (n=22) Neuroendocrine tumor (n=7), Large cell Neuroendocrine carcinoma (n=3) and Poorly differentiated carcinoma with neuroendocrine features (n=11). Features that are of help include scanty cytoplasm, fine or coarse granular chromatin, nuclear moulding and streaking, cells adhering to vessels, inconspicuous nucleoli, nuclear debris in small cell carcinomas; larger cell size, a moderate amount of cytoplasm, coarse granular chromatin in large cell neuroendocrine carcinomas; uniformity of cell size, round to plasmacytoid cells with stippled chromatin and rosette formation in carcinoid tumors. The identification of neuroendocrine morphology in cytology specimens is crucial as this would be the initial step towards using the appropriate markers for confirmation, which in turn has got therapeutic and prognostic significance.

Diagnosis from Tissue: Histology and Identification.

The diagnosis and initiation of appropriate treatment against invasive fungal infections depend upon accurate identification of pathogens by pathologists and clinical microbiologists. Histopathology is often critical in providing diagnostic insight in patients with suspected fungal infections, and such findings are incorporated into the definitions of proven or probable disease caused by certain pathogens. Such examinations can offer provisional identifications of fungal organisms, which can help guide initial therapy while laboratory results are pending. Common etiologic agents of invasive mycoses may be recognized based on morphologic characteristics observed in tissue and biologic fluids, such as those obtained from bronchoalveolar lavage and bronchial washings. However, care should be taken in the interpretation of these findings, as there may be a false sense of the ability to correctly categorize fungal organisms to the genus or species level by morphologic features alone. Studies have demonstrated discordant results between histopathology and laboratory results due to overlapping morphologic features, morphologic mimics, and sampling errors. Thus, histopathology plays an integral role in providing a differential of potential fungal pathogens but must be combined with results from laboratory studies, including cultures, antigen tests, serology, and molecular assays, in order to improve accuracy in the identification of etiologic agents of fungal infections. Inaccurate identification of the infecting organism can lead to inappropriate antifungal therapy and possibly poor clinical outcomes.

Donor Airway Bile Acid as a Biomarker of Aspiration and Predictor of Post Lung Transplant Outcomes

<h3>Purpose</h3> Emesis and aspiration contribute to donor lung damage and may promote allograft dysfunction. Currently, there is no clinical tool to detect occult aspiration and objectively assess its severity in donor lungs. A previous study by our group identified that aspirated total bile acids (TBA) in donor bronchial wash (BW) was associated with acceptability of donor lungs for transplant. Herein, we seek to validate this finding in a large retrospective cohort and assess the association between donor TBA and recipient outcomes. <h3>Methods</h3> TBA was measured in available BW samples of 605 consecutive lung donors from 2012 to 2018. 90% specificity threshold was used to derive a TBA cut-off that identified donor lungs unsuitable for transplant. We further assessed associations between BW TBA concentrations and performance of donor lungs undergoing ex vivo lung perfusion (EVLP), as well as post-transplant recipient outcomes. <h3>Results</h3> Donor TBA was higher in lungs deemed unsuitable for transplant compared to those suitable for direct transplant and those requiring further assessment on EVLP (Figure A; Mann-Whitney U test). In lungs assessed on EVLP, higher TBA concentration in donor BW correlated with lower pH, higher lactate levels, and higher pro-inflammatory cytokines in EVLP perfusate. In lungs not assessed on EVLP, TBA cut-off of 1245nM was able to differentiate donor lungs suitable for transplantation vs declined with 90% specificity. Based on this cut-off, high donor TBA was associated with worse post-transplant recipient outcomes: longer time to extubation (p<0.001) (Figure B; log-rank test) and shorter time to chronic lung allograft dysfunction (p=0.01). <h3>Conclusion</h3> In a large retrospective cohort we observed that high TBA in donor bronchial wash was associated with suitability of donor lungs for transplant, performance on EVLP, and adverse recipient outcomes. TBA measurement may be useful to triage donor lungs for further assessment on EVLP and potential pre-transplant therapeutic interventions.