Comments: This retrospective study assessed the role of FB in the management of organ transplant recipients. Lung transplant recipients with surveillance bronchoscopies were excluded from the study. Indications for FB included suspected pulmonary infection by either abnormal chest radiograph or respiratory symptoms. One hundred sixty-eight FBs were performed in 129 patients. The mean age of patients who underwent transplantation was 50 ± 8.4 years. There were 84 male and 45 female patients. One hundred twenty-one (72%) were lung transplants recipients, 34 (20%) were renal transplant recipients, 6 (4%) were liver transplant recipients, 4 (2%) were heart transplant recipients, and 3 (2%) were bone marrow transplant recipients. Mean posttransplantation time was 30.3 ± 7.1 months (range, 1–61 months posttransplantation). Patients underwent BAL, and the specimens were analyzed for bacteriology, virology, and fungal and mycobacterial cultures. BLB was obtained in 65% of patients. Diagnosis was obtained using FB in 82 patients (49%). Infection was diagnosed in 21 patients (12%), rejection was diagnosed in 25 lung transplant recipients (15%), nonspecific interstitial pneumonitis and bronchiolitis obliterans organizing pneumonia were diagnosed in 34 patients (20%), and malignancy was diagnosed in 2 patients (1.2%). In 86 cases (51%), FB was nondiagnostic. Microorganisms isolated by FB were bacterial in seven cases (one was mycobacterial tuberculosis), fungal in two cases, viral in five cases, and of mixed infection in seven cases. Depending on the results from FB, antimicrobial therapy was changed in 51% of cases. Antibiotic treatment was discontinued in 59 cases (35%). No death was related to FB. Three patients later died of infection: one as a result of Pseudomonas pneumonia, one as a result of cytomegalovirus pneumonitis, and one as a result of mixed pulmonary infection (Pseudomonas, cytomegalovirus, and Aspergillus). Overall hospital mortality in posttransplantation patients with infection was 9.6%. Nonpulmonary causes, such as cardiovascular diseases or malignancy, were causes of death in another 16 patients (11.7%). The authors concluded that FB is an extremely useful tool to evaluate transplant recipients with suspected pulmonary infection. The procedure is safe and should be performed early in any transplant recipients with respiratory symptoms or chest radiograph abnormalities. Both infectious and noninfectious complications are common in patients after solid organ transplantation or bone marrow transplantation. When respiratory symptoms and chest radiographs along with nonrespiratory symptoms of infection appear in these patients, the first consideration is to obtain respiratory specimens to identify the causative agent so that appropriate therapy can be promptly instituted. However, not all patients with respiratory symptoms have underlying infection. Many of the pulmonary features in this group of patients are secondary to noninfectious complications of organ transplant. This study shows that the results from FB led to change in antimicrobial therapy in 51% of cases, and antibiotic treatment was discontinued in 59 cases (35%). These numbers are significant and impressive, compared with several studies that have addressed this issue.