Mucosal or endobronchial biopsies (EBB) are typically used in the diagnosis of directly visualized bronchial lesions, infection, and sarcoidosis, but their utility in the evaluation of lung transplant recipients is controversial. EBB represents an attractive alternative to transbronchial biopsy (TBB): EBB provides straightforward sampling of airway pathology with decreased complication rates due to minimal and visualizable bleeding and the elimination of pneumothorax risk. In lung transplant recipients, EBB may be obtained when TBB is too high-risk, including in the setting of acute lung allograft dysfunction (ALAD) requiring mechanical ventilation or in advanced chronic lung allograft dysfunction (CLAD). Most centers do not include EBB in post-transplant surveillance or for-cause bronchoscopy protocols, possibly due to a lack of a common histologic interpretation system. Previous work has demonstrated that lymphocytic inflammation in lung transplant EBB is associated with acute cellular rejection and future risk for CLAD, but these have not translated into subsequent studies on clinical utility or into clinical practice. Recent multicenter studies suggest that gene expression-based diagnostics leveraging EBB may outperform histologic grading and provide important prognostic utility in predicting graft loss. Herein, we will review what is known about the lung transplant mucosa including recent diagnostic advances and propose how EBB analyses could be incorporated into research studies and clinical workflows. We propose that mucosal sampling could provide safe, consistent, and informative data to improve patient outcomes after lung transplant.

中文翻译：

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肺移植支气管内活检：被遗忘的标本成熟。


黏膜或支气管内活检 （EPB） 通常用于诊断直接可见的支气管病变、感染和结节病，但它们在评估肺移植受者中的效用存在争议。EBB 是经支气管活检 （TBB） 的一种有吸引力的替代方案：EBB 提供了直接的气道病理取样，由于出血量最小且可观察，并发症发生率降低，并消除了气胸风险。在肺移植受者中，当 TBB 风险过高时，包括在需要机械通气的急性肺同种异体移植物功能障碍 （ALAD） 或晚期慢性同种异体肺移植物功能障碍 （CLAD） 的情况下，可以获得 EBB。大多数中心在移植后监测或因故支气管镜检查方案中不包括 EBB，这可能是由于缺乏通用的组织学解释系统。以前的工作表明，肺移植 EBB 中的淋巴细胞炎症与急性细胞排斥反应和 CLAD 的未来风险有关，但这些尚未转化为后续的临床效用研究或临床实践。最近的多中心研究表明，利用 EBB 的基于基因表达的诊断可能优于组织学分级，并在预测移植物损失方面提供重要的预后效用。在本文中，我们将回顾有关肺移植粘膜的已知信息，包括最近的诊断进展，并提出如何将 EBB 分析纳入研究和临床工作流程。我们建议粘膜取样可以提供安全、一致和信息丰富的数据，以改善肺移植后的患者预后。