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Open lung biopsy for diffuse disease in patients with and without previously transplanted solid organs.
Sebastian Defranchi1, Alejandro M Bertolotti, Carlos A Vigliano
1Cardiovascular and Thoracic Surgery Division, Favaloro Foundation, Buenos Aires, Argentina. sdefranchi@ffavaloro.org
The Annals of Thoracic Surgery
|August 25, 2010
Summary
Surgical lung biopsy (SLB) changes treatment in one third of patients with diffuse lung disease, regardless of solid-organ transplant status. Patients on mechanical ventilation during SLB face higher risks of complications and death.
Area of Science:
- Pulmonology
- Transplant Surgery
- Critical Care Medicine
Background:
- Conflicting studies exist on whether surgical lung biopsy (SLB) alters treatment for diffuse lung disease.
- Limited data addresses treatment modification post-SLB in solid-organ transplant recipients.
Purpose of the Study:
- To determine and compare treatment change rates after SLB for diffuse lung disease in patients with and without solid-organ transplantation history.
Main Methods:
- Retrospective review of patients undergoing SLB for diffuse lung disease between March 2004 and March 2009.
- Comparison of treatment changes between solid-organ transplant recipients and non-transplant patients.
Main Results:
- Thirty-three percent of patients (20/60) experienced a treatment change post-SLB, with no significant difference between transplant (10/34) and non-transplant (10/26) groups.
- Transplant patients were more likely to be on mechanical ventilation during SLB (12/34 vs. 3/26).
- Mechanical ventilation at SLB correlated with increased postoperative complications and in-hospital mortality.
- Mechanical ventilation, cancer diagnosis, and transplant history independently predicted survival.
Conclusions:
- SLB modifies treatment in approximately one-third of patients, irrespective of solid-organ transplant status.
- Mechanical ventilation during SLB significantly elevates risks for postoperative complications and mortality.