Clinical lung and heart/lung transplantationSuccess of lung transplantation without surveillance bronchoscopy
Section snippets
Group comparisons
Between January 1995 and December 1999, a total of 91 consecutive patients underwent single (n = 36) or bilateral sequential (n = 55) LT at Ochsner Clinic. Pre-operative and post-operative variables were abstracted for analysis. The Oschner Clinic (OC) cohort was then compared with 5,430 patients transplanted contemporaneously as identified from the ISHLT Registry data, obtained with permission. Basic demographic data, underlying diseases, and survival curves were compared between the 2 groups.
Results
Table I shows pre-operative and post-operative characteristics of the Ochsner group. Table II illustrates demographic characteristics and pre-transplantation diagnoses of OC and ISHLT groups. In addition to a larger proportion of females and African Americans, cystic fibrosis and idiopathic pulmonary fibrosis comprised a greater percentage of LARs in the OC cohort when compared with the ISHLT cohort. In contrast, pulmonary hypertension was observed in a larger percentage of ISHLT LARs. Also of
Discussion
Transbronchial biopsy is considered the gold standard for determining the cause of respiratory decompensation in LARs. When clinical derangements are apparent, the ability of FOB with TBB/BAL to diagnose infection or rejection ranges between 69% and 83%.15, 16 This procedure’s sensitivity and specificity for acute rejection has been reported to be high as 94% and 100% in symptomatic LARs,1 although the diagnostic yield appears to be highly variable between institutions. At least 5 adequate TBB
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