Berita Kesehatan
Lung allograft transbronchial cryobiopsy for critical ventilated patients: a randomised trial
Rabu, 25 Jan 2023 10:40:51

Karina Loor, Mario Culebras, Irene Sansano, Antonio Álvarez, Judith Sacanell, Marina García-de-Acilu, Cristina Berastegui, Eva Polverino, David Clofent,Javier de Gracia

European Respiratory Journal 2023 61: 2102354; DOI: 10.1183/13993003.02354-2021

Abstract

Background Transbronchial lung cryobiopsy is an emerging technique for diagnosing pulmonary rejection. However, no prospective studies of this procedure for critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit (ICU) have been performed.

Methods From March 2017 to January 2020, we performed a prospective, randomised, comparative study to assess the diagnostic yield, histological quality and safety of transbronchial lung biopsy using biopsy forceps, a 1.9-mm cryoprobe or a 2.4-mm cryoprobe.

Results 89 out of 129 consecutive transbronchial biopsy procedures (forceps group, 28 procedures; 1.9-mm cryoprobe group, 31 procedures; 2.4-mm cryoprobe group, 30 procedures) were randomised. Compared with lung samples from the forceps and 1.9-mm cryoprobe groups, lung samples from the 2.4-mm cryoprobe group allowed the most definitive diagnoses (p<0.01 and p=0.02, respectively), the most diagnoses of acute lung rejection (p<0.01 and p=0.01, respectively) and the most diagnoses of rejection severity (p<0.01 and p<0.01, respectively). These samples were larger (p<0.01 and p=0.04, respectively), had the most adequate alveolar tissue (p<0.01 and p=0.02, respectively), had more vessels per procedure (p<0.01 and p=0.01, respectively) and had no significant crush artefacts. Moderate bleeding was observed in 23% of cases (p=0.01 and p=0.08, respectively). No severe bleeding was observed.

Conclusions Transbronchial lung biopsy using a 2.4-mm cryoprobe allows the safe collection of lung tissue samples from critically ill lung transplant recipients who require mechanical ventilation in the ICU and has good diagnostic performance.

Transbronchial lung biopsy using a 2.4-mm cryoprobe allows the safe collection of lung tissue samples from critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit and has good diagnostic performance https://bit.ly/3zq38ND

Footnotes

  • Published in volume 61, issue 1 of the European Respiratory Journal on 6 January 2023; republished 20 January 2023 with amendments to the authors' affiliation details.

  • Author contributions: J. de Gracia and K. Loor designed the initial study. M. Culebras, A. Álvarez and I. Sansano substantially contributed to the conception of the work. A. Álvarez, M. Culebras, M. García-de-Acilu, J. Sacanell, I. Sansano, J. de Gracia and K. Loor performed acquisition, analysis or interpretation of the data for the work. D. Clofent and C. Berastegui performed analysis and interpretation of the data for the work. M. Culebras, A. Álvarez, E. Polverino, K. Loor and J. de Gracia drafted the initial manuscript. All authors contributed to the development of the work and approved the final version.

  • This article has an editorial commentary: https://doi.org/10.1183/13993003.01942-2022

  • This clinical trial was prospectively registered at ClinicalTrials.gov with identifier number NCT03090581. Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, appendices and study protocol), will be available beginning 6 months and ending 24 months after article publication, to researchers who provide a methodologically sound proposal who have been approved by an independent review committee identified for this purpose. Data will be made available to achieve the aims in the approved proposal and for individual participant data meta-analysis. Proposals should be directed to karinairaida.loor@vallhebron.cat or jgracia@separ.es. To gain access, data requestors will need to sign a data access agreement.

  • Conflicts of interest: The authors declare that they have no conflicts of interest directly or indirectly related to the content of the article.

  • Support statement: This research was funded by Grupo Menarini Spain SA.

  • Received August 27, 2021.
  • Accepted July 18, 2022.