The use of multiple transbronchial biopsies as the standard approach to evaluate lung allograft rejection

Flexible bronchoscopy with transbronchial biopsy (TBB) is routinely performed in adult and pediatric lung transplant recipients. The clinical signs and symptoms of acute cellular rejection (ACR) are often identical to those of infection. TBB is a fairly sensitive and specific tool in which to diagnose ACR and can be performed safely in children of all ages. The utility of TBB is unquestioned during periods of worsening clinical symptoms. The utility of TBB for routine surveillance of the allograft remains unproven. The data suggests that during the first 4-6 months post-transplant there is a high incidence of clinically silent ACR. The significance of subclinical rejection in lung transplantation is unknown. Randomized, controlled trials are required to determine if multiple surveillance TBB, can impact the incidence of obliterative bronchiolitis.