Background: Most studies of the role of bronchoscopy and the epidemiology of pulmonary infections in post-transplant patients focus on stem cell transplant (SCT) recipients. The purpose of this study is to evaluate the diagnostic yield of bronchoscopy in both solid organ transplant (SOT) and SCT recipients who present with pneumonia and determine the frequency of change in therapy due to bronchoscopy.
Methods: We retrospectively reviewed medical records of SOT (liver or kidney) and SCT recipients who presented with signs and symptoms of pneumonia and who underwent bronchoscopy from January 1, 2008 to December 31, 2010 at The Mount Sinai Hospital in New York.
Results: 53 cases were identified: 20 (37.7%) kidney transplant recipients; 18 (34%) allogeneic SCT recipients; 10 (18.9%) liver transplant recipients; and 5 (9.4%) autologous SCT recipients. Mean age was 55.87[+/-] 13.82 years, and 34 (64.2%) were male. Prior to bronchoscopy 42 (79.2%) received antibiotics, 18 (34%) received antifungals, and 10 (18.9%) received antivirals. The bronchoscopy was diagnostic (yielded an organism or non-infectious diagnosis) in 28 (52.8%) cases. Infectious etiologies identified were 13 fungi (6 Pneumocystis, 4 Aspergillus, 2 Cryptococcus, 1 Rhizopus), 5 bacteria (Klebsiella, Nocardia, 3 Haemophilus influenzae), 3 nontuberculous mycobacteria, 2 viruses (1 parainfluenza virus, 1 respiratory syncytial virus), and 1 case of Mycobacterium tuberculosis. There was no statistically significant relationship between timing of bronchoscopy or previous antimicrobial treatment and the diagnostic yield. The presence of shortness of breath and diffuse findings on chest radiograph were statistically significantly associated with a diagnostic procedure. Patients with focal findings on chest radiograph were significantly less likely to have a diagnostic procedure (RR 0.057 (0.005-0.614)). Earlier time to bronchoscopy showed a trend towards being significantly related to the diagnostic yield (p=0.05). There was a significant relationship between a diagnostic result from bronchoscopy and a change in antimicrobial therapy (p=0.031).
Conclusion: In transplant recipients with the presumptive diagnosis of pneumonia, bronchoscopy can aid in making a specific diagnosis and lead to therapeutic interventions. Earlier time to bronchoscopy showed a trend towards being significantly related to the diagnostic yield.
To cite this abstract in AMA style:Gitman M, Huprikar S, Factor S. Utility of Bronchoscopy in Post-Transplant Patients Presenting with Symptoms and Signs of Pneumonia [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/utility-of-bronchoscopy-in-post-transplant-patients-presenting-with-symptoms-and-signs-of-pneumonia/. Accessed February 22, 2020.
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