Correlation of Pre-Transplantation Clinical Diagnoses with Post-Transplantation Pathologic Diagnoses in Lung Transplantation Patients: A Single Institution Study of 748 Transplants.
Kennon Miller, Marie Budev, Carol Farver. Cleveland Clinic, OH
Background: Lung transplantation is the main therapy option for many endstage pulmonary diseases. However, accurately diagnosing the specific lung pathology prior to transplantation may be challenging. Evaluation of the explanted lung provides an accurate measure of the pre-clinical diagnosis.
Design: We reviewed clinical and pathologic records for lung transplantations performed at the Cleveland Clinic between the years of 1995 and 2009. For each transplant, the preoperative clinical diagnosis was compared with explanted lung pathologic findings diagnosed by pulmonary pathologists, (CF and AA). Discrepancies between pre-operative and post-operative diagnoses were tabulated. A discrepancy was counted as a major discrepancy if the explanted lung demonstrated a pathology inconsistent with the pre-operative diagnosis.
Results: Of the 748 lung transplantations performed between the years of 1995-2009, 744 pathology reports were available for review. The patients ranged from 2 to 75 years of age (mean 50.7 years). The most common lung diseases were chronic obstructive pulmonary disease (32.6%), idiopathic pulmonary fibrosis (29%), cystic fibrosis (14.6%), alpha-1 antitrypsin deficiency (6.3%), and sarcoidosis (3.6%).
Major discrepancies between the pre-transplantation clinical diagnosis and the post-transplantation pathologic diagnosis were found in 0.8% (6) patients. Three of these cases demonstrated UIP on the explant evaluation while the pre-operative diagnosis was NSIP.
Unexpected neoplasms were found in 1.9% (14) of explanted lungs. Adenocarcinoma was found in 8 explanted lungs and squamous cell carcinoma in 5 explanted lungs. One patient was found to have both adenocarcinoma and squamous cell carcinoma. The remaining two neoplasms were a BALT lymphoma and a metastatic non-small cell carcinoma of unknown primary found in a lymph node.
Micro-organisms were identified histologically in 9.1% (68) of explanted lungs. Histoplasma was identified in 50% (34) of those lungs, Aspergillus in 29.4% (20) and Mycobacteria in 20.6% (14). Pneumocystis and Herpes simplex virus were each found in one lung.
Conclusions: Pre-operative clinical evaluation of lung transplant candidates is very accurate in defining their pulmonary disease. Neoplasms are missed in pre-clinical work-up of lung transplantation in 1.9% of patients. Explanted lungs show micro-organisms by tissue stains in 20.6% of the cases.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 233, Monday Morning