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Surveillance bronchoscopy in children during the first year after lung transplantation: Is it worth it?
C Benden1, O Harpur-Sinclair, A S Ranasinghe
1Cardio-Respiratory and Critical Care Division, Great Ormond Street Hospital for Children National Health Service Trust, London, UK.
Insights
Routine surveillance bronchoscopy in pediatric lung transplant recipients reveals significant rates of silent rejection and subclinical infections. Early detection through bronchoscopy aids in timely treatment of these critical post-transplant complications.
Area of Science:
- Pediatric Transplantation
- Pulmonary Medicine
- Immunology
Background:
- Established routine surveillance bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy for pediatric lung and heart-lung transplant recipients since 2002.
- Utilized a revised treatment protocol for post-transplant care in pediatric patients.
Purpose of the Study:
- To determine the prevalence of rejection and pathogens (bacterial, viral, fungal) in asymptomatic pediatric lung transplant recipients.
- To compare these findings with the prevalence in symptomatic pediatric lung transplant recipients.
Main Methods:
- Retrospective analysis of pediatric patients undergoing lung or heart-lung transplantation between January 2002 and December 2005.
- Scheduled surveillance bronchoscopies at 1 week, 1, 3, 6, and 12 months post-transplant.
- Classification of bronchoscopies based on the presence or absence of specific symptoms indicative of complications.
Main Results:
- Rejection was diagnosed in 4% of asymptomatic and 12% of symptomatic recipients.
- Pathogens were detected in 29% of asymptomatic and 69% of symptomatic patients.
- Bronchoscopy yielded diagnoses in 35% of asymptomatic and 85% of symptomatic children (p < 0.001), with a 3.2% complication rate.
Conclusions:
- A significant proportion of pediatric lung transplant recipients experience subclinical rejection or infection within the first year.
- Routine surveillance bronchoscopy is effective in detecting these silent complications.
- Early detection facilitates targeted treatment, improving outcomes in pediatric lung transplant patients.
Background:
Since January 2002, routine surveillance bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy has been performed in all paediatric recipients of lung and heart-lung transplants at the Great Ormond Street Hospital for Children, London, UK, using a newly revised treatment protocol.
Aims:
To report the prevalence of rejection and bacterial, viral or fungal pathogens in asymptomatic children and compare this with the prevalence in children with symptoms.
Participants:
The study population included all paediatric patients undergoing single lung transplantation (SLTx), double lung transplantation (DLTx) or heart-lung transplantation between January 2002 and December 2005.
Methods:
Surveillance bronchoscopies were performed at 1 week, and 1, 3, 6 and 12 months after transplant. Bronchoscopies were classified according to whether subjects had symptoms, defined as the presence of cough, sputum production, dyspnoea, malaise, decrease in lung function or chest radiograph changes.
Results:
Results of biopsies and BAL were collected, and procedural complications recorded. 23 lung-transplant operations were performed, 12 DLTx, 10 heart-lung transplants and 1 SLTx (15 female patients). The median (range) age of patients was 14.0 (4.9-17.3) years. 17 patients had cystic fibrosis. 95 surveillance bronchoscopies were performed. Rejection (> or =A2) was diagnosed in 4% of biopsies of asymptomatic recipients, and in 12% of biopsies of recipients with symptoms. Potential pathogens were detected in 29% of asymptomatic patients and in 69% of patients with symptoms. The overall diagnostic yield was 35% for asymptomatic children, and 85% for children with symptoms (p < 0.001). The complication rate for bronchoscopies was 3.2%.
Conclusions:
Many children have silent rejection or subclinical infection in the first year after lung transplantation. Routine surveillance bronchoscopy allows detection and targeted treatment of these complications.
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