Thoracic Medicine Department and Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
Curr Opin Organ Transplant. 2009 Oct;14(5):494-8. doi: 10.1097/MOT.0b013e3283300a3b.
Clinically mandated transbronchial biopsy is universally regarded as the most efficient tool to establish pathology in the allograft. However, the utility of surveillance transbronchial biopsy to facilitate early detection and treatment of acute pulmonary allograft rejection is a matter of current debate. The purpose of this review is to summarize the evidence for and against the performance of surveillance bronchoscopy postlung transplantation, to discuss the risk/benefit ratio and the application of this procedure in the individual patient.
Detection of silent acute rejection of the pulmonary allograft remains an important benefit of surveillance bronchoscopy although definitive evidence for a positive impact on survival or prevention of development of the bronchiolitis syndrome (BOS) is yet to be demonstrated. Perhaps the wrong target has been the focus as new evidence suggests that high grade lymphocytic bronchiolitis is the important independent risk factor for the development of BOS and death after lung transplantation. Providing effective therapies for lymphocytic bronchiolitis can be developed there is now strong support for performance of surveillance transbronchial biopsy. Most studies attest to a low risk of severe complications.
Surveillance bronchoscopy is useful to detect asymptomatic acute rejection but also to determine the presence and severity of lymphocytic bronchiolitis, which should be the new target of therapeutic endeavours. It is acknowledged that the true risk/benefit ratio of surveillance bronchoscopy may differ between programs so each case deserves individual consideration.
临床要求的经支气管活检被普遍认为是诊断移植物病理学的最有效工具。然而，监测性经支气管活检在促进急性肺移植物排斥反应的早期发现和治疗中的作用仍存在争议。本文的目的是总结支持和反对肺移植后进行监测性支气管镜检查的证据，讨论该程序的风险/获益比及其在个体患者中的应用。
尽管尚未证明监测性支气管镜检查对生存或预防细支气管炎综合征（BOS）的发展有积极影响，但检测肺移植物的隐匿性急性排斥反应仍然是监测性支气管镜检查的一个重要益处。也许关注的重点是错误的，因为新的证据表明，高级别淋巴细胞性细支气管炎是肺移植后发生 BOS 和死亡的重要独立危险因素。如果能够开发出针对淋巴细胞性细支气管炎的有效治疗方法，那么现在就强烈支持进行监测性经支气管活检。大多数研究证实严重并发症的风险较低。
监测性支气管镜检查有助于检测无症状的急性排斥反应，但也有助于确定淋巴细胞性细支气管炎的存在和严重程度，这应该是治疗努力的新目标。人们认识到，监测性支气管镜检查的真实风险/获益比可能因项目而异，因此每个病例都值得个体化考虑。
