Sarıbaş Ertan, Halis Ayse Nigar, Çıtak Sevinç, Gecmen Gonca, Kazan Ahmet Murat, Vayvada Musatafa, Cardak Murat Ersin, Taşçı Ahmet Erdal
Department of Pulmonology, Kartal Kosuyolu High Specialization Education & Research Hospital, Istanbul, Turkey.
Department of Thoracic Surgery, Kartal Kosuyolu High Specialization Education & Research Hospital, Istanbul, Turkey.
BMC Pulm Med. 2024 Dec 31;24(1):639. doi: 10.1186/s12890-024-03464-1.
Bronchoscopy plays a critical role in the diagnosis and management of lung transplant recipients. We retrospectively evaluated the safety, complications, and efficacy of transbronchial biopsy (TBB) in detecting and grading early rejection.
We retrospectively assessed the complications associated with TBB and the adequacy of pathological diagnoses in patients who underwent lung transplantation at Koşuyolu Yüksek İhtisas Training and Research Hospital from December 1, 2016, to April 30, 2023.
In this study, we retrospectively analyzed 290 TBB procedures performed on 59 out of 94 lung transplant recipients. Of the study cohort, 72.9% (n = 43) were male, with a median age of 44.3 years. The proficiency of TBB pathology was found to be 90.7% (n = 263) for acute rejection (AR), 46.5% (n = 135) for airway inflammation, 50% (n = 145) for chronic lung allograft dysfunction (CLAD) with bronchiolitis obliterans (BO), and 89.6% (n = 260) for chronic vascular rejection. Acute rejection (AR) was detected in 23.4% (n = 68). Pneumothorax was observed in 2.07% (n = 6) of the cases. A chest tube was inserted in four patients to manage pneumothorax, while two patients received only supplemental oxygen due to minimal pneumothorax.
TBB is considered a very safe procedure when basic precautions are followed. The rate of pneumothorax, a complication associated with TBB, is low. Despite advances in immunology and genetics, TBB remains the gold standard for detecting acute rejection (AR) following lung transplantation. Given its diagnostic value, we believe that the procedure should not be avoided due to the risks of complications.
支气管镜检查在肺移植受者的诊断和管理中起着关键作用。我们回顾性评估了经支气管活检（TBB）在检测和分级早期排斥反应中的安全性、并发症及有效性。
我们回顾性评估了2016年12月1日至2023年4月30日在科叙约卢尤克谢伊特萨培训与研究医院接受肺移植患者中与TBB相关的并发症以及病理诊断的充分性。
在本研究中，我们回顾性分析了94例肺移植受者中59例接受的290次TBB操作。研究队列中，72.9%（n = 43）为男性，中位年龄为44.3岁。发现TBB病理对急性排斥反应（AR）的诊断准确率为90.7%（n = 263），对气道炎症的诊断准确率为46.5%（n = 135），对伴有闭塞性细支气管炎（BO）的慢性肺移植功能障碍（CLAD）的诊断准确率为50%（n = 145），对慢性血管排斥反应的诊断准确率为89.6%（n = 260）。检测到23.4%（n = 68）的患者发生急性排斥反应（AR）。2.07%（n = 6）的病例观察到气胸。4例患者插入胸管以处理气胸，而2例患者因气胸轻微仅接受补充氧气。
遵循基本预防措施时，TBB被认为是一种非常安全的操作。气胸是与TBB相关的一种并发症，其发生率较低。尽管免疫学和遗传学取得了进展，但TBB仍然是肺移植后检测急性排斥反应（AR）的金标准。鉴于其诊断价值，我们认为不应因并发症风险而避免该操作。
