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Sakpal SV, Donahue S, Crespo HS, Auvenshine C, Agarwal SK, Nazir J, Santella RN, Steers J. Utility of fiber-optic bronchoscopy in pulmonary infections among abdominal solid-organ transplant patients: A comprehensive review. Respir Med 2018; 146:81-86. [PMID: 30665523 DOI: 10.1016/j.rmed.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
Pulmonary infections are frequent complications in abdominal solid-organ transplantation (aSOT) which may threaten patient and allograft survival. Accurate diagnosis and treatment of pulmonary infections in this population can be challenging. Immunosuppressive therapy not only increases the risk of acquiring opportunistic and non-opportunistic infections, but it also impairs the inflammatory responses associated with microbial invasion which in an otherwise normal host produce clinical and radiologic responses that allow for early identification of the offending pathogen. Serologic testing is not a reliable diagnostic modality. Direct microbiological sampling is often necessary to make a definitive diagnosis early in the clinical course to optimize timely, targeted therapy while reducing the risk of developing antimicrobial resistance, and minimize adverse effects of therapy, if any. Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) or transbronchial lung biopsy (TBB) offers such diagnostic advantage and possesses a potential therapeutic value too. This comprehensive review discusses the potential benefits of FOB alongside its risks and complications, indications and contraindications, and techniques. Additionally, the essay highlights FOB's utility and yield specifically with regard to type and timing of infections in aSOT patients.
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Affiliation(s)
- Sujit Vijay Sakpal
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA; Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Steven Donahue
- Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Hector Saucedo Crespo
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Christopher Auvenshine
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Suresh Kumar Agarwal
- Division of Acute Care, Trauma, Surgical Critical Care, Department of Surgery, Duke University, Durham, NC, USA
| | - Jawad Nazir
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA
| | - Robert N Santella
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Jeffery Steers
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA
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