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Surveillance transbronchial biopsies in infant lung and heart-lung transplant recipients
Don Hayes1, Peter B Baker, Benjamin T Kopp
1Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Transbronchial biopsy (TBB) is a safe and effective method for monitoring infant lung and heart-lung transplant recipients for allograft rejection and airway inflammation. This surveillance technique provides adequate tissue samples for diagnosis.
Area of Science:
- Pediatric transplantation
- Pulmonary medicine
- Surgical pathology
Background:
- Limited data exist on surveillance transbronchial biopsy (TBB) for allograft rejection in infants post-lung or heart-lung transplantation.
- Infant lung and heart-lung transplant recipients require effective monitoring for rejection and airway inflammation.
Purpose of the Study:
- To evaluate the safety and efficacy of surveillance TBB in infants undergoing lung or heart-lung transplantation.
- To assess the adequacy of tissue obtained via TBB for diagnosing allograft rejection and small airway inflammation in this population.
Main Methods:
- Retrospective review of pediatric patients under one year of age who underwent lung or heart-lung transplantation since 2005.
- Analysis of surveillance TBB procedures, including number performed per patient, tissue adequacy, and diagnostic yield.
- Assessment of allograft rejection (ISHLT grading) and B-grade inflammation from TBB specimens.
Main Results:
- Four infants underwent transplantation (3 heart-lung, 1 lung) with a mean age of 5.5 months.
- 16 surveillance TBB procedures were performed, with adequate tissue (≥5 pieces with alveoli) obtained in 81%.
- No acute allograft rejection was identified in 88% of TBBs; one case of A2 rejection was detected. B-grade assessment showed B0 in 50% and B1R in 12%.
Conclusions:
- Surveillance TBB can be safely performed in inpatient and outpatient settings for infant lung and heart-lung transplant recipients.
- TBB provides adequate tissue for detecting acute allograft rejection and small airway inflammation in this vulnerable population.
- This procedure is a valuable tool for post-transplant monitoring in pediatric recipients.
Abstract:
There are limited published data on surveillance TBB for the identification of allograft rejection in infants after lung or heart-lung transplantation. We performed a retrospective review of children under one yr of age who underwent lung or heart-lung transplant at our institution. Since 2005, four infants were transplanted (three heart-lung and one lung). The mean age (±s.d.) at the time of transplant was 5.5 ± 2.4 (range 3-8) months. A total of 16 surveillance TBB procedures were completed in both inpatient and outpatient settings, with a range of 3-7 performed per patient. A minimum of five acceptable tissue pieces with expanded alveoli were obtained in 81% (13/16) of TBB procedures and a minimum of three pieces in 88% (14/16). There was no evidence of acute allograft rejection in 88% (14/16) of TBB procedures. One TBB procedure yielded two tissue specimens demonstrating A2 acute allograft rejection. One TBB procedure failed to yield tissue with sufficient alveoli. Additionally, B-grade assessment identified B0 in 50% (8/16), B1R in 12% (2/16), and BX (ungradeable or insufficient sample) in 38% (6/16) of biopsy procedures, respectively. In conclusion, TBB may be safely performed as an inpatient and outpatient procedure in infant lung and heart-lung transplant recipients and may provide adequate tissue for detecting acute allograft rejection and small airway inflammation.