Original article
General thoracic
Open Lung Biopsy for Diffuse Disease in Patients With and Without Previously Transplanted Solid Organs

Presented at the Forty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 25–27, 2010.
https://doi.org/10.1016/j.athoracsur.2010.05.053Get rights and content

Background

Studies on whether surgical lung biopsy (SLB) modifies the treatment of patients with diffuse lung disease are conflicting, and information is limited on whether it alters treatment in solid-organ transplant recipients. Our objective was to determine and compare the rate of treatment change after SLB for diffuse lung disease in patients with and without a history of solid-organ transplantation.

Methods

Patients undergoing SLB for diffuse lung disease between March 2004 and March 2009 were identified. A retrospective review was performed.

Results

Sixty patients had SLB. Thirty-four patients (57%) had solid-organ transplantation. Twenty of 60 patients (33%) had a change in treatment as a result of the findings of the SLB. No significant differences in the treatment change rate were found between the transplant and nontransplant groups (10 of 34 versus 10 of 26; p = 0.46). Transplant patients were more likely to be on mechanical ventilation at the time of SLB (12 of 34 versus 3 of 26; p = 0.03). Mechanical ventilatory support at the time of SLB was associated with increased postoperative complications (odds ratio, 6.20; 95% confidence interval [CI], 1.70 to 22.66; p = 0.006) and in-hospital mortality (odds ratio, 9.75; 95% CI, 2.54 to 37.38; p = 0.001). Being on mechanical ventilation (hazard ratio, 3.91; 95% CI, 1.40 to 10.93; p = 0.009), a diagnosis of cancer (hazard ratio, 13.20; 95% CI, 2.87 to 60.78; p = 0.001), and a history of solid-organ transplantation (hazard ratio, 5.52; 95% CI, 1.08 to 28.14; p = 0.04) were independent predictors of survival.

Conclusions

Surgical lung biopsy changes treatment in one third of patients, with no significant difference between patients without transplantation and solid-organ transplant recipients. Patients who undergo SLB while on mechanical ventilation have a significantly increased risk of postoperative complications and death.

Section snippets

Patients and Methods

The study was approved by the institutional review board at the Favaloro Foundation.

The medical records of all patients who underwent SLB between March 2004 and March 2009 were reviewed. Data collected and analyzed included patient demographics, radiographic findings, operative reports, pathologic and microbiologic results, and change in therapy after SLB.

Results

Sixty patients underwent SLB during the study period. Baseline demographics are shown in Table 1. Thirty-four patients (57%) had a history of a solid-organ transplant. Fourteen were lung transplants (41%), 8 patients had kidney transplants (23%), 6 had heart transplants (18%), 5 had heart-lung transplants (15%), and 1 patient had a liver transplant (3%). The median elapsed time from the time of transplantation to SLB was 1,290 days (279 to 2,043 days). The median follow-up time was 164.64 days

Comment

Surgical lung biopsy is considered the best method for reaching a correct and specific diagnosis in DLD [14]. However, despite advances in surgical techniques, particularly the adoption of thoracoscopy, SLB still has substantial morbidity and mortality [9, 10]. The rate of treatment change after SLB varies in the literature from 8% to almost 85% [3, 4, 5, 8, 15]. However, none of the series reported in the literature have compared the rate of treatment change in solid-organ transplant

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