Diagnostic bronchoscopy in solid-organ and hematopoietic stem cell transplantation

• Published in: Annals of the American Thoracic Society Vol. 10; no. 1; pp. 39 - 49
• Main Authors: Harris, Bianca, Lowy, Franklin David, Stover, Diane Elizabeth, Arcasoy, Selim Mehmet
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01-02-2013
• Subjects: Bronchoscopy - adverse effects; Bronchoscopy - methods; Bronchoscopy - statistics & numerical data; Early Diagnosis; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunocompromised Host; Lung Diseases - diagnosis; Lung Diseases - etiology; Opportunistic Infections - complications; Opportunistic Infections - diagnosis; Opportunistic Infections - microbiology; Organ Transplantation - adverse effects; Outcome and Process Assessment (Health Care); Patient Acuity; Patient Selection; Postoperative Complications - diagnosis; Risk Assessment; Time-to-Treatment
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/annalsats.201212-114fr

Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes. This approach may be most critical when an underlying infectious etiology is suspected. In the absence of prompt diagnostic information on which to base effective treatment, the risks associated with empiric antimicrobial therapy, including medication side effects and the development of antibiotic resistance, compound the potential harm of delaying targeted management.