[1775] Transbronchial Lung Biopsy Is Not an Optimal Method for Evaluating Chronic Rejection in Lung Transplant Patients.

Yanxia Li, Zhihong Hu, James Gagermeier, Maria M Picken. Loyola University Medical Center, Maywood, IL; Loyola Unversity Medical Center, Maywood, IL

Background: Lung transplantation is a rescue therapy for patients with end-stage lung disease. Chronic rejection post transplant (tx)
remains a frequent cause of death. Hitherto, the diagnosis of rejection has been made by transbronchial or wedge biopsy (bx). However, the sensitivity of lung bx in the diagnosis of rejection is still unclear.
Design: We reviewed biopsy and autopsy records of the past 19 years from a single lung tx center, and compared the findings from the patient's premortem bx to that of the autopsy (= the gold standard). We also evaluated the diagnostic potency of chronic rejection vs. bx satisfaction rate using the presence of at least 5 fragments of alveolated lung tissue as the criteria.
Results: Bx and autopsy findings from 71 lung tx patients [25F/46M] were reviewed. Most chronic rejection occurred > 6 months post lung tx. The latest bx of 75% of patients was performed within one month prior to the autopsy, with a median of 14 days (ranging from 1 day to 7 months). There were 6 patients diagnosed with chronic rejection from premortem transbronchial bx, whereas 19 patients were diagnosed at autopsy. Hence, the sensitivity for diagnosis of chronic rejection by transbronchial bx was 36.8%, and the specificity was 100%. Wedge bx was performed on 5 patients, none of whom were diagnosed with chronic rejection and this was completely consistent with their autopsy findings. 15 patients were diagnosed with acute rejection by the latest bx, but only 4 of them at autopsy.

Comparison of Diagnosis of Rejection at Bx and Autopsy

	Transbronchial Bx	Autopsy
Acute Rejection	15	4
Chronic Rejection	6	19

All patients with a premortem diagnosis of chronic rejection had a satisfactory transbronchial bx (6/6, 100%) while those that were not diagnosed premortem had a bx satisfaction rate of 55% (7/13).

Diagnosis of Chronic Rejection by Transbronchial Bx vs. Bx Satisfaction Rate

Bx Diagnosis	# of Patients (n=19)	Bx Satisfaction rate (>=5pcs of alveolated lung tissue)
Chronic rejection	6	100%
Other	13	55%

Conclusions: Diagnosis of chronic rejection by txbx is less sensitive than by autopsy. The diagnostic rate of acute rejection was 4 times higher in transbronchial bx than by autopsy, probably due to the immunosuppressant therapy instigated upon diagnosis. Wedge bx is a more reliable tool for the exclusion of chronic rejection than transbronchial bx. A satisfactory transbronchial bx is required for the accurate diagnosis of chronic rejection.
Category: Pulmonary

Wednesday, March 2, 2011 9:30 AM

Poster Session V # 270, Wednesday Morning