Utility of microbiologic testing in surveillance bronchoscopy following lung transplantation: A retrospective cohort study

Authors

William P. Dillon, Henry Ford HealthFollow
Tommy P. Acosta, Henry Ford Health
Andrew Failla, Henry Ford HealthFollow
Julio Corrales, Henry Ford Health
George Alangaden, Henry Ford HealthFollow
Mayur Ramesh, Henry Ford HealthFollow

Recommended Citation

Dillon WP, Acosta TP, Failla A, Corrales J, Alangaden G, and Ramesh M. Utility of microbiologic testing in surveillance bronchoscopy following lung transplantation: A retrospective cohort study. Transpl Infect Dis 2022; 24(6):e13989.

Document Type

Article

Publication Date

12-1-2022

Publication Title

Transplant infectious disease

Abstract

BACKGROUND: The utility of surveillance bronchoscopy (SB) for the clinical management of lung transplant recipients (LTRs) is undefined. This study evaluates the role of SB in the monitoring and care of LTRs.

METHODS: We retrospectively analyzed all LTRs who had SB at Henry Ford Hospital in Detroit, Michigan between August 2014 and August 2019. Bronchoscopies performed for clinical symptoms, new radiographic abnormalities, and to assess stents or acute rejection were excluded. A total of 107 LTRs and 449 bronchoscopies were analyzed. The primary outcome was the rate of change in clinical care based on microbiologic and pathologic test results. Secondary outcomes were rates of microbiologic and pathologic test positivity and rates of adverse effects.

RESULTS: The most common microbiologic tests performed on bronchoalveolar lavage were bacterial (96.9%), fungal (95.3%), and acid-fast bacillus (95.1%) stains and cultures. Of 2560 microbiologic tests, 22.0% were positive and resulted in therapy changes for 2.9%. Positive galactomannan, acid-fast bacillus tests, and Pneumocystis jirovecii antigen/polymerase chain reaction did not result in therapy changes. Of the 370 transbronchial biopsies performed, 82.2% were negative for acute rejection and 13% were positive for A1/A2 rejection. Immunosuppressive therapy changes occurred after 15.8% with reduction in immunosuppression due to positive microbiologic tests in 16.9%. Adverse events occurred in 8.0% of patients.

CONCLUSION: Diagnostic stewardship is warranted when performing SB in LTRs.

Medical Subject Headings

Humans; Bronchoscopy; Retrospective Studies; Bronchoalveolar Lavage Fluid; Lung Transplantation; Lung; Graft Rejection

PubMed ID

36380574

Volume

24

Issue

6

First Page

13989

Last Page

13989