Open lung biopsy in pediatric patients with respiratory failure after abdominal transplantation

Usefulness of Lung Biopsy in Pediatric Pulmonary Conditions

Lung biopsy, performed as a diagnostic procedure in children with pulmonary disease to guide treatment, may not provide a diagnosis or change therapy. We therefore reviewed our experience with the procedure to determine its use. We reviewed all children undergoing lung biopsy at two large children's hospitals, 2001 to 2010. Lesions were categorized as either diffuse or localized based on final radiological interpretations. Pathological interpretations and subsequent treatment regimens were reviewed for specificity of diagnoses and any changes in therapy. Of 99 patients, there were 14 diffuse and 85 localized pulmonary lesions. Biopsy confirmed the radiological diagnosis in 29 (29%), 71 per cent (70) receiving a new histopathological diagnosis, or a definitive one from a range or radiological possibilities, both diffuse (10 of 14) and diffuse lesions (60 of 85, both 71%). Forty-five per cent (44 of 99) had sufficient clinical data to ascertain treatment before and after biopsy. A significant change in treatment occurred in only 16 per cent (seven of 44) without a significant difference between diffuse (33% [three of nine]) and localized (11% [four of 35]) lesions ( P = 0.38). Twenty-five per cent (25 of 99) of patients undergoing lung biopsy died. Lung biopsy is performed for conditions with a high mortality rate. The procedure yields a definitive diagnosis in the majority of cases but infrequently changes therapy.

Nonsurgical care of intestinal and multivisceral transplant recipients: a review for the intensivist

Intestinal and multivisceral transplantation has evolved from an experimental procedure to the treatment of choice for patients with irreversible intestinal failure and serious complications related to long-term parenteral nutrition. Increased numbers of transplant recipients and improved survival rates have led to an increased prevalence of this patient population in intensive care units. Management of intestinal and multivisceral transplant recipients is uniquely challenging because of complications arising from the high incidence of transplant rejection and its treatment. Long-term comorbidities, such as diabetes, hypertension, chronic kidney failure, and neurological sequelae, also develop in this patient population as survival improves. This article is intended for intensivists who provide care to critically ill recipients of intestinal and multivisceral transplants. As perioperative care of intestinal/multivisceral transplant recipients has been described elsewhere, this review focuses on common nonsurgical complications with which one should be familiar in order to provide optimal care. The article is both a review of the current literature on multivisceral and isolated intestinal transplantation as well as a reflection of our own experience at the University of Miami.

Adenovirus infections in transplant recipients

Adenoviruses are increasingly recognized as contributors to morbidity and mortality among stem cell and solid-organ transplant recipients. Clinical presentations range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. The limited clinical data available support the use of cidofovir for many of these illnesses. Prospective studies are needed to better understand the pathogenesis of and therapeutic options for adenoviral infections in this patient population.