Invasive biopsy is effective and useful after lung transplant.

Area of Science:

• Pulmonary Medicine
• Transplant Surgery
• Interventional Pulmonology

Background:

• Transbronchial biopsy (TBB) is standard post-lung transplant but often non-diagnostic.
• Unexplained clinical deterioration necessitates more invasive diagnostic methods.
• Open lung biopsy (OLB) and video-assisted thoracoscopy (VAT) are employed for definitive diagnoses.

Purpose of the Study:

• To evaluate the risks and benefits of invasive lung biopsies (OLB/VAT) in lung transplant recipients.
• To assess the diagnostic yield and impact on treatment decisions.

Main Methods:

• Retrospective review of 51 invasive biopsies (41 OLB, 10 VAT) in 45 lung transplant recipients over 12 years.
• Biopsies performed between 7 days and 11 years post-transplant, with 73% in the first year.

Main Results:

• Invasive biopsies yielded new diagnoses in 37% and confirmed suspicions in 47% of patients.
• 57% of biopsies led to a change in treatment, primarily medication adjustments.
• Mortality within 30 days of biopsy was 20% (9/45), with most deaths in already ventilated patients.

Conclusions:

• Invasive biopsies (OLB/VAT) offer a high rate of clinically useful results in lung transplant recipients.
• These procedures frequently guide treatment modifications, improving patient management.
• Invasive biopsies are a safe intervention, particularly for ambulatory patients.