Bronchiolitis obliterans syndrome in heart-lung transplantation: surveillance biopsies

Am J Respir Crit Care Med. 1997 May;155(5):1705-10. doi: 10.1164/ajrccm.155.5.9154880.


Transbronchial biopsies (TBBs) are useful to diagnose acute rejection and infection in patients with lung transplants. The value of routine surveillance biopsies (S-TBBs) is not known, and such biopsies with a clinical indication are not without risk and are expensive. One hundred twenty-six 6-mo survivors of heart-lung transplantation (HLT) were studied to determine the effect of stopping S-TBBs on the development of bronchiolitis obliterans syndrome (BOS) and subsequent survival. Fifty-one received transplants while S-TBB was part of routine care (group A), and 75 received transplants after this practice was stopped (group B). There was no difference in patient characteristics. Group A had shorter graft ischemia (p < 0.01) and longer postoperative ventilation (p < 0.01). Maintenance immunosuppression was similar, but group A had more steroid pulses in the second 6 mo after HLT (p < 0.01). The number of patients free from any functional deterioration at 49 to 60 mo after HLT declined to 39% in group A and 64% in group B. The risk of developing BOS grade 1 in group A relative to group B was 1.63 (95% confidence intervals: 0.96-2.79, p = 0.07). Patient survival was similar in the two groups. A total of 86 TBBs were taken in the absence of any signs or symptoms and had low diagnostic yield. In summary, there was no increased incidence of BOS after stopping S-TBBs.

MeSH terms

  • Actuarial Analysis
  • Adult
  • Biopsy, Needle* / adverse effects
  • Bronchiolitis Obliterans / diagnosis*
  • Bronchiolitis Obliterans / etiology
  • Female
  • Graft Rejection / diagnosis
  • Heart-Lung Transplantation / adverse effects*
  • Heart-Lung Transplantation / mortality
  • Humans
  • Lung / pathology
  • Male
  • Middle Aged
  • Survival Rate