Key result
Stopping routine surveillance transbronchial biopsies in heart-lung transplant survivors did not increase the incidence of bronchiolitis obliterans syndrome (RR for routine vs stopped 1.63; P=0.07).
Why the study?
Does stopping routine surveillance transbronchial biopsies increase the risk of bronchiolitis obliterans syndrome or reduce survival in heart-lung transplant recipients?
Cohort (n=126)
Does stopping routine surveillance transbronchial biopsies increase the risk of bronchiolitis obliterans syndrome or reduce survival in heart-lung transplant recipients?
Relative Risk: 1.63 (95% CI 0.96–2.79)
p-value: p=0.07
Stopping routine surveillance transbronchial biopsies in heart-lung transplant recipients does not increase the incidence of bronchiolitis obliterans syndrome and avoids unnecessary procedures.
May support de-escalating routine surveillance biopsies in heart-lung recipients; leaves open confirmation by randomized trials.
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.
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Tamm et al. (1997) conducted a cohort in Heart-lung transplantation (n=126). Stopping routine surveillance transbronchial biopsies (S-TBBs) vs. Routine surveillance transbronchial biopsies was evaluated on Development of bronchiolitis obliterans syndrome (BOS) grade 1 (RR 1.63, 95% CI 0.96-2.79, p=0.07). Stopping routine surveillance transbronchial biopsies in heart-lung transplant survivors did not increase the incidence of bronchiolitis obliterans syndrome (RR for routine vs stopped 1.63; P=0.07).
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