Eyüboğlu F Ö, Küpeli E, Bozbaş S S, Ozen Z E, Akkurt E S, Aydoğan C, Ulubay G, Akçay S, Haberal M
Department of Pulmonary Medicine, Baskent University School of Medicine, Ankara, Turkey.
Transplant Proc. 2013;45(10):3458-61. doi: 10.1016/j.transproceed.2013.09.024.
Recipients of solid organ transplants (SOTs) are at higher risk to develop pulmonary infections (PIs) owing to their immunocompromised state. Flexible bronchoscopy (FB) is frequently performed to diagnose nature of these infections. The aim of 12-year review was to evaluate the demographic characteristics of SOT recipients with PIs and to study diagnostic utility of FB in this group of patients.
Medical records of patients who underwent SOT as well as FB between 2000 and 2012 were retrospectively reviewed. Patients' demographics, type of transplantation, primary diagnoses, thoracic computed tomography (CT) findings, total blood count and chemistry, indication for FB, FB results, specimen culture results, and suspected and final diagnoses were all recorded. If the bronchoscopy findings altered medical management and produced improvement in PI, the procedure was considered diagnostic.
Ninety of 998 liver, heart, or kidney transplant recipients underwent FB (73 renal, 16 liver, and 1 heart; mean age, 42.3 ± 12.1 years) during the study period. CT findings were as follows: Consolidation (49.4%), lymphadenopathy (3.4%), nodular infiltrates (5.6%), and cavitary lesion (1.1%). FB was unremarkable in 29, but showed increased secretions in 33 patients (36.7%), chronic mucosal changes in 9 (10%), edema in 7 (7.8%), mucosal plaque in 7 (7.8%), friable mucosa in 3 (3.3%), and endobronchial lesion in 2 (2.2%). A total of 29 bronchial washings (BW; 32.6%) and 10 bronchoalveolar lavages (BAL; 11.2%) were performed. PI was diagnosed in 82% of the patients (n = 73). In 32 patients (36%), micro-organism growth was observed on either BW or BAL. Mycobacterium tuberculosis was detected in 6 (6.7%), Staphylococcus aureus in 4 (4.4%), Moraxella catharralis in 4 (4.4%), Candida albicans in 6 (6.7%), Klebsiella pneumonia in 2 (2.2%), Escherichia coli in 2 (2.2%), Streptococcus pneumoni in 2 (2.2%), Stenotrofomonas maltofilia in 1 (1.1%), Aspergillus fumigatus in 4 (4.5%), and Pseudomonas aeruginosa in 1 (1.1%). Final diagnosis was established by FB (n = 33) with a diagnostic yield of 36%. No significant finding was observed between the type of the transplant and the culture results (P > .05).
Suspected PI is the most common indication for FB in SOT recipients. It may identify the causative organism in >30% of patients. Tuberculosis was found to be the most frequent agent, which is not surprising from such an endemic area. Bacteria were more common than fungal or viral micro-organisms. FB should be considered in SOT recipients presenting with lung infiltrates and suspected to have PI.
实体器官移植（SOT）受者由于免疫功能低下，发生肺部感染（PI）的风险更高。经常进行纤维支气管镜检查（FB）以诊断这些感染的性质。这项为期12年的回顾性研究旨在评估发生PI的SOT受者的人口统计学特征，并研究FB在该组患者中的诊断效用。
回顾性分析2000年至2012年期间接受SOT以及FB检查的患者的病历。记录患者的人口统计学资料、移植类型、初步诊断、胸部计算机断层扫描（CT）结果、全血细胞计数和生化指标、FB检查的指征、FB检查结果、标本培养结果以及疑似诊断和最终诊断。如果支气管镜检查结果改变了治疗方案并使PI病情改善，则该检查被认为具有诊断价值。
在研究期间，998例肝、心或肾移植受者中有90例接受了FB检查（73例肾移植、16例肝移植和1例心脏移植；平均年龄42.3±12.1岁）。CT检查结果如下：实变（49.4%）、淋巴结肿大（3.4%）、结节状浸润（5.6%）和空洞性病变（1.1%）。29例FB检查结果正常，但33例患者（36.7%）显示分泌物增多，9例（10%）有慢性黏膜改变，7例（7.8%）有水肿，7例（7.8%）有黏膜斑，3例（3.3%）有黏膜易碎，2例（2.2%）有支气管内病变。共进行了29次支气管灌洗（BW；32.6%）和10次支气管肺泡灌洗（BAL；11.2%）。82%的患者（n = 73）被诊断为PI。在32例患者（36%）中，BW或BAL检查发现有微生物生长。检测到结核分枝杆菌6例（6.7%）、金黄色葡萄球菌4例（4.4%）、卡他莫拉菌4例（4.4%）、白色念珠菌6例（6.7%）、肺炎克雷伯菌2例（2.2%）、大肠埃希菌2例（2.2%）、肺炎链球菌2例（2.2%）、嗜麦芽窄食单胞菌1例（1.1%）、烟曲霉4例（4.5%）和铜绿假单胞菌1例（1.1%）。最终诊断通过FB检查确定（n = 33），诊断率为36%。移植类型与培养结果之间未观察到显著差异（P >.05）。
疑似PI是SOT受者进行FB检查最常见的指征。它可能在超过30%的患者中识别出病原体。结核病是最常见的病原体，在这样一个地方病流行地区并不奇怪。细菌比真菌或病毒微生物更常见。对于出现肺部浸润并疑似患有PI的SOT受者，应考虑进行FB检查。
