Vitulo P, Cremaschi P, Arbustini E, Volpato G, Volpini E, Martinelli L, Fracchia C, Rossi A
Pneumology, IRCCS Policlinico S. Matteo, University of Pavia, Italy.
Monaldi Arch Chest Dis. 1996 Feb;51(1):12-5.
From March 1991 to December 1993, 30 patients underwent transbronchial biopsy (TBB) after lung transplantation (16 with a heart lung transplant, 7 with a single lung transplant, and 7 with a double lung transplant). The now standard TBB technique was used. Initially, TBB was performed only when clinically indicated, i.e. when there were sound reasons to suspect the existence of acute rejection (AR) or pulmonary infection. From 1992, all the patients were entered into a prospective study, the protocol of which called for serial "surveillance" TBB to be performed, in addition to those for clinical indications, 15 days, 2, 3, 6, 9 and 12 months after the transplant, and then annually. One hundred and twenty nine transbronchial biopsies were performed in 2.5 yrs. Of the 121 successful TBBs, 54 (45%) were positive, i.e. showed signs of acute rejection. Sixty six of 129 (51%) of the TBBs were performed because of clinical indications, 45 of them (68%) within the first 3 months following the transplant. The other 63 were surveillance biopsies. About two thirds of the clinically indicated TBBs and more than a quarter of the surveillance TBBs, yielding adequate samples, were positive for AR > or = A2 (mild rejection). The sensitivity and specificity of the method in detecting AR were 91 and 100%, respectively. The overall incidence of complications was 10.8% (pneumothorax in 9% of cases). There were no deaths correlated to the procedure. Our results confirm the decisive role of TBB in the diagnosis of acute lung rejection. The high incidence of mild acute rejection, and the occasional finding of moderate acute rejection in stable asymptomatic patients, support the use of surveillance TBB in the first 6 months.
1991年3月至1993年12月，30例患者在肺移植后接受了经支气管活检（TBB）（16例接受心肺移植，7例接受单肺移植，7例接受双肺移植）。采用了目前的标准TBB技术。最初，仅在临床有指征时进行TBB，即当有充分理由怀疑存在急性排斥反应（AR）或肺部感染时。从1992年起，所有患者均进入一项前瞻性研究，该研究方案要求除临床指征活检外，在移植后15天、2、3、6、9和12个月以及之后每年进行系列“监测”TBB。在2.5年中进行了129次经支气管活检。在121次成功的TBB中，54次（45%）呈阳性，即显示有急性排斥反应的迹象。129次TBB中有66次（51%）是因临床指征进行的，其中45次（68%）在移植后的前3个月内。另外63次是监测活检。约三分之二因临床指征进行的TBB以及超过四分之一获得足够样本的监测TBB，AR≥A2（轻度排斥反应）呈阳性。该方法检测AR的敏感性和特异性分别为91%和100%。并发症的总发生率为10.8%（气胸发生率为9%）。没有与该操作相关的死亡病例。我们的结果证实了TBB在急性肺排斥反应诊断中的决定性作用。轻度急性排斥反应的高发生率以及在稳定无症状患者中偶尔发现中度急性排斥反应，支持在头6个月使用监测TBB。
