Routine Surveillance Bronchoscopy At First-Month In Lung Transplantation Recipients – A One Year Single Center Experience Analysis

A. Crutu*^a (Dr), A. Hanna^a (Dr), V. De Montpréville^a (Dr), V. Florea^a (Dr), P. Pradere^a (Dr), S. Feuillet^a (Dr), G. Dauriat^a (Dr), J. Le Pavec^a (Dr), E. Fadel^a (Prof)

^a Marie Lannelongue Hospital, Le Plessis-Robinson, FRANCE

* nacrutu@yahoo.com

Background: Bronchoscopy with transbronchial biopsy (TBBX) remains the current “gold standard” for the diagnosis of the acute cellular rejection (ACR), which represents one of the most important risk factors for the chronic allograft dysfunction. Therefore, the early detection of asymptomatic ACR episodes may play a role in its prevention. The aim of our study was to identify the number of ACR detected in routine surveillance bronchoscopy (SB).

Methods: In our center we perform a routine SB with TBBX at first-month after lung transplant for all asymptomatic patients. The lung transplant recipients can have, at any time, a clinically indicated bronchoscopy (CB). We performed a retrospective analysis of the data concerning the patients that had lung transplant during the calendar year of 2021. The bronchoscopy procedures performed at first-month post-transplant were analysed and the number of ACR was recorded.

Results: In 2021, 40 bilateral lung transplant (LTx) were performed in our center. Sex distribution was 19 (47.5%) males and 21 (52.5%) females. 5 patients were excluded from the analysis (no bronchoscopy procedure performed at first-month for 4 of them and non-contributively bronchoscopy procedure for one patient). 19 bronchoscopy procedures were routine SB at first-month post-transplant. 12 of them (63.15%) found pathologic changes associated with ACR. In all these cases therapeutic changes were made. 16 bronchoscopy procedures were CB. 9 of them (56.5%) found ACR. The overall complication rate was low and no death was reported in relation with the procedure.

Conclusion: In our experience the information obtained by the SB at first-month post-transplant influenced the therapeutic management in a significant number of cases. In the literature the role of SB remains controversial and there is no consensus on the frequency in which we should be performing it. An adequately powered prospective randomized controlled study comparing SB to CB is required.

Disclosure of funding source(s): none