Surgical lung biopsy in children after hematopoietic cell transplantation

Background/Purpose

Pulmonary complications are some of the leading causes of morbidity and mortality in immunocompromised pediatric patients. We sought to assess the value of surgical lung biopsy (SLB) in hematopoietic cell transplantation (HCT) pediatric patients.

Methods

A retrospective review of patients who underwent SLB within one year of HCT between 1999 and 2015 was performed.

Results

Twenty-nine patients (15 females, 14 males) with a median age of 10 years (range, 0.6–23) were identified. Median interval between HCT and SLB was 114.8 days (range, 16–302). At surgery, 11 (38%) patients were intubated, and 7 (24%) were receiving supplemental oxygen. The most common histological finding was cryptogenic organizing pneumonia in 8 cases (27%), followed by infection in 7 (24%). Perioperative complications (17%) included bronchopleural fistula (n = 2), splenic laceration from a trocar injury (n = 2), and hemothorax (n = 1). Changes in therapy occurred in 25 patients (86%). Twenty-four (83%) patients survived more than 30 days post SLB, and the overall survival rate was 41% with a median follow-up of 8.5 years (range, 1–13).

Conclusion

SLB appears to be safe and informative in pediatric patients after HCT and led to changes in therapy in most patients. However, long-term survival after this procedure was < 50%, reinforcing the fact that pulmonary complications are some of the leading causes of mortality in these patients.

Type of Study

Retrospective analysis.

Level of Evidence

Level IV.