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Invasive biopsy is effective and useful after lung transplant

Lookup NU author(s): Dr Clare Burdett, Stephen Clark, Professor John Dark

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Abstract

BACKGROUND: Transbronchial biopsy (TBB) is widely used after lung transplant but may not be diagnostic. Our group has used invasive approaches, open lung biopsy (OLB) or video-assisted thoracoscopy (VAT), to establish a definitive diagnosis in unexplained clinical deterioration. We sought to demonstrate the risks and benefits of this approach. METHODS: A retrospective review was made of the case notes of the patients undergoing OLB or VAT during a 12-year period from August 1996. RESULTS: During a 12-year period in 442 recipients, there were 51 invasive biopsies in 45 patients (6 had 2 procedures), of which 41(80%) were OLB and 10 (20%) were VAT. Time of biopsy ranged from 7 days to 11 years after transplant. Thirty-seven (73%) took place in the first year, including 12 (24%) within the first 30 days. Nine patients died within 30 days of biopsy; 7 of them were already ventilated. Overall, biopsy provided a new unsuspected diagnosis in 37% of patients and confirmed the diagnostic suspicion in 47%. In only 16% of patients did it fail to provide a result that was clinically useful. The results of 29 (57%) biopsies led to a change in treatment. Sixty-three percent of new diagnoses and 71% where clinical suspicion was confirmed resulted in a treatment change. In all but 2 cases, a change was made to medication. CONCLUSIONS: In this large series of invasive biopsies, there was a high rate of useful results, with a frequent change in treatment. Invasive biopsies are a safe intervention in ambulatory patients. J Heart Lung Transplant 2010;29:759-63 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.

Publication metadata

Author(s): Burdett CL, Critchley RJ, Black F, Barnard S, Clark SC, Corris PA, Gould KF, Butt T, Dark JH

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2010

Volume: 29

Issue: 7

Pages: 759-763

Print publication date: 18/04/2010

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.healun.2010.03.002

DOI: 10.1016/j.healun.2010.03.002

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