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13 - Bronchoscopy in the Lung Transplant Patient

Published online by Cambridge University Press:  07 July 2009

By
Anne L. Fuhlbrigge
Edited by
Armin Ernst
Armin Ernst
Affiliation:
Harvard Medical School/Beth Israel Deaconess Medical Center
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Summary

INTRODUCTION

Lung transplantation has rapidly evolved since the first operation in the early 1960s and has become an established treatment for a variety of patients with end-stage lung disease. Bronchoscopy is an essential tool in the diagnosis and management of lung transplant recipients. In this chapter we will outline four areas in which bronchoscopy plays a critical role in the care of patients undergoing lung transplantation: (1) evaluation of potential lung donors, (2) surveillance for acute rejection, (3) evaluation and treatment among lung transplant recipients presenting with new symptoms or deteriorating respiratory function, and (4) visualization of the anastomosis and management of airway complications.

THE ROLE OF BRONCHOSCOPY IN THE ASSESSMENT OF POTENTIAL LUNG DONORS

Flexible bronchoscopy is an essential part of the evaluation of all potential lung donors. Bronchoscopy can assess for evidence of lung injury, inflammation, aspiration, and infection. If bronchoscopy shows no anatomic abnormality, endobronchial lesions, or secretions, acceptance of the organ for donation is appropriate. However, only about one third of persons meeting criteria for brain death, and being considered for donation, will have a normal bronchoscopy. A normal bronchoscopy is not a requirement for accepting a potential lung donor; the findings on flexible bronchoscopy can help select donors acceptable for donation and donors that should be rejected.

Detailed Inspection of the Anatomy

An important finding during bronchoscopy is the presence of anatomic variations that influence the operative procedure and potential use of the organ.

Type
Chapter
Information
Introduction to Bronchoscopy , pp. 126 - 133
Publisher: Cambridge University Press
Print publication year: 2009

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