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Vol. 60. Issue 11.
Pages 698-704 (November 2024)
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Vol. 60. Issue 11.
Pages 698-704 (November 2024)
Original Article
Transbronchial Cryobiopsy Versus Transbronchial Forceps Biopsy for Acute Cellular Rejection Detection in Lung Transplantation: A Meta-Analysis
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Yan Luoa, Sheng-ping Lib,
Corresponding author
lishengping1218@163.com

Corresponding author.
a Department of Pediatrics, Chengdu First People's Hospital, Chengdu China
b Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu China
Highlights

  • Transbronchial cryobiopsy (TBCB) represents a promising approach for monitoring after lung transplantation.

  • TBCB has the advantage over transbronchial forceps biopsy (TBFB) in obtaining larger tissue samples and reducing tissue artifacts.

  • TBCB improves the diagnostic yield for acute and chronic rejection following lung transplantation, with safety comparable to TBFB.

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Tables (2)
Table 1. Characteristic features of included studies in the present meta-analysis.
Table 2. The methods and materials of included studies in the present meta-analysis.
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Additional material (6)
Abstract
Background

Transbronchial cryobiopsy (TBCB) provides larger tissue samples and improved sampling depth, but its role in diagnosing acute cellular rejection (ACR) in lung transplant patients is unclear due to limitations in existing studies. To address this, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of TBCB.

Methods

A thorough literature review was conducted to evaluate TBCB in post-lung transplant surveillance, assessing the quality of studies and conducting a meta-analysis comparing diagnostic yields of TBCB and transbronchial forceps biopsy (TBFB), as well as evaluating procedural complications.

Results

Our meta-analysis, incorporating 11 studies with a total of 915 patients, showed that TBCB had a diagnostic rate of 38.27% (225/588) for ACR post-lung transplantation, notably higher than the 35.65% (251/704) for TBFB. The inverse-variance weighted odds ratio was calculated at 2.32 (95% confidence interval: 1.24–4.32; p=0.008). Funnel plot analysis indicated no major publication bias. Meta-analysis of 6 studies demonstrated that TBCB, compared to TBFB, significantly increased the diagnostic rate for chronic rejection post-transplantation (25.00% vs 10.93%, p=0.005). Our meta-analysis comparing the safety of TBCB and TBFB in post-lung transplant surveillance found no significant differences in moderate to severe bleeding (5.99% vs 6.31%, p=0.98), or pneumothorax incidence (3.90% vs 3.29%, p=0.75).

Conclusions

Our study indicates that TBCB may enhance the diagnosis of acute and chronic rejection post-lung transplantation with a safety profile comparable to TBFB. Further research and the development of standardized procedures are warranted to ensure the safe and effective application of TBCB in broader clinical practice.

Keywords:
Transbronchial lung cryobiopsy
Transbronchial forceps biopsy
Lung transplant
Acute cellular rejection
Meta-analysis

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