经支气管冷冻与活检钳肺移植受者的疗效和安全性比较：402 例分析。

Efficacy and safety of trans-bronchial cryo in comparison with forceps biopsy in lung allograft recipients: Analysis of 402 procedures.

机构信息

Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.

Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel.

出版信息

Clin Transplant. 2018 Apr;32(4):e13221. doi: 10.1111/ctr.13221. Epub 2018 Feb 28.

DOI:10.1111/ctr.13221

PMID:29436115

Abstract

BACKGROUND

Trans-bronchial forceps biopsy (TBFB) is the gold standard to establish the presence of allograft rejection or infection after lung transplantation. We aimed to analyze the diagnostic yield and safety of trans-bronchial cryobiopsy (TBCB) in lung allografts.

METHODS

Retrospective analysis of 402 TBB procedures in 362 lung recipients was performed between 2011 and 2016. Half of the cases (201) were performed by TBCB and the other half by TBFB. One hundred random slides of TBB specimens from lung allografts were reviewed for artifacts, bleeding, and histological evidence.

RESULTS

Both TBB groups were comparable in age, gender distribution, and time following transplantation. Acute rejection was diagnosed in 21.9% of the TBCB group vs 14.9% in the TBFB group (P = .09) and only 2 cases (1%) of nondiagnostic tissue in TBCB group and 4 cases (2%) in TBFB group (P = .685). Complications of pneumothorax and bleeding occurred in 9 (4.5%) vs 8 (4%) and 5 (2.5%) vs 4 (2%) in TBCB vs TBFB groups, respectively. The TBCB specimens were larger than TBFB (average 16.6 vs 6.6 mm ; P < .001). Crush and bleeding artifacts were seen in 11 (22%) and 23 (46%) of TBFB, respectively, yet none in TBCB group (P < .001).

CONCLUSION

Trans-bronchial cryobiopsy is safe and effective for diagnosis of lung allograft rejection.

摘要

背景

经支气管钳活检（TBFB）是诊断肺移植后移植物排斥或感染的金标准。我们旨在分析经支气管冷冻活检（TBCB）在肺移植物中的诊断效果和安全性。

方法

对 2011 年至 2016 年间 362 例肺受体的 402 次 TBFB 操作进行回顾性分析。其中一半（201 例）采用 TBCB，另一半（201 例）采用 TBFB。对 100 例肺移植标本的 TBFB 标本进行随机切片检查，以评估其有无伪影、出血和组织学证据。

结果

TBCB 组和 TBFB 组在年龄、性别分布和移植后时间方面具有可比性。TBCB 组中急性排斥反应的诊断率为 21.9%，TBFB 组为 14.9%（P=.09），且 TBCB 组仅有 2 例（1%）组织无法诊断，TBFB 组有 4 例（2%）（P=.685）。TBCB 组气胸和出血并发症的发生率分别为 9 例（4.5%）和 8 例（4%），TBFB 组分别为 8 例（4%）和 4 例（2%）（P=.45）。TBCB 组标本明显大于 TBFB 组（平均 16.6 毫米 vs 6.6 毫米；P<.001）。TBFB 组中分别有 11 例（22%）和 23 例（46%）出现挤压和出血伪影，而 TBCB 组中未见此类伪影（P<.001）。