Cagle P T, Brown R W, Frost A, Kellar C, Yousem S A
Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
Mod Pathol. 1995 Feb;8(2):137-42.
Chronic rejection in the form of obliterative bronchiolitis (OB) associated with chronic inflammation and fibrosis of bronchi (CIB) is a significant cause of morbidity and mortality in long-term heart-lung and single-lung transplant recipients. To determine the utility of transbronchial biopsy in diagnosing chronic rejection, we reviewed 24 transbronchial biopsies (TBBs) performed at the time of, or subsequent to, a clinical diagnosis of OB of chronic rejection in eight heart-lung and single-lung transplant recipients at the Methodist Hospital, Houston, Texas. These were compared with 36 randomly selected control TBBs from 14 patients without a clinical or histopathologic diagnosis of OB of chronic rejection at any time in their course. In the former group of TBBs, nine (38%) were diagnostic of OB and seven (29%) showed CIB suspicious for chronic rejection. TBBs diagnosed as negative had significantly fewer samples of tissue (1.0 versus > 3) and significantly smaller size of tissue (1.44 mm versus > 4.5 mm) than did TBBs in the OB or CIB categories. When strict criteria were used, no false diagnoses of OB of chronic rejection were made on control TBBs. However, OB associated with bronchiolitis obliterans organizing pneumonia of viral pneumonitis was present in three (8%) and CIB in 15 (42%) of control TBB associated with acute rejection and infection. This finding emphasizes the nonspecificity of CIB. We conclude that TBB is potentially useful in diagnosing OB of chronic rejection in some cases and in suggesting chronic rejection in other cases. Inadequate sampling by the bronchoscopist was the major reason for a negative biopsy.
闭塞性细支气管炎（OB）形式的慢性排斥反应，伴有支气管慢性炎症和纤维化（CIB），是长期心肺和单肺移植受者发病和死亡的重要原因。为了确定经支气管活检在诊断慢性排斥反应中的作用，我们回顾了德克萨斯州休斯顿卫理公会医院8例心肺和单肺移植受者在临床诊断慢性排斥反应的OB时或之后进行的24次经支气管活检（TBB）。将这些活检与14例在病程中任何时候均无慢性排斥反应的临床或组织病理学诊断的OB的患者中随机选择的36次对照TBB进行比较。在前一组TBB中，9例（38%）诊断为OB，7例（29%）显示CIB可疑为慢性排斥反应。诊断为阴性的TBB与OB或CIB类别中的TBB相比，组织样本明显更少（1.0个对大于3个），组织大小明显更小（1.44毫米对大于4.5毫米）。当使用严格标准时，对照TBB未出现慢性排斥反应的OB的误诊。然而，在与急性排斥反应和感染相关的对照TBB中，3例（8%）存在与病毒性肺炎的机化性肺炎相关的OB，15例（42%）存在CIB。这一发现强调了CIB的非特异性。我们得出结论，TBB在某些情况下可能有助于诊断慢性排斥反应的OB，在其他情况下提示慢性排斥反应。支气管镜检查取样不足是活检阴性的主要原因。
