Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation.
Bhorade SM, Husain AN, et al.Chest 2013; 143(6): 1717-1724.
Aims
To determine the interobserver variability in grading transbronchial biopsy specimens for acute rejection after lung transplantation as part of the AIRSAC (Comparison of a Tacrolius/Sirolimus/Prednisone Regimen vs Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in lung transplantation) study.
Interventions
All patients received IL-2 receptor antagonist induction therapy followed by initial immunosuppression with tacrolimus, azathioprine and corticosteroids until 90 days post transplant. The randomized groups were then administered with either tacrolimus, azathioprine and prednisone or tacrolimus, sirolimus and prednisone.
Participants
181 adult lung transplant recipients aged between 18-65 years.
Outcomes
The outcomes included transbronchial biopsy specimen grading between each site pathologist and the central pathologist. The grading of the specimens were also collected during specific time points after transplantation to determine if time after transplant had an impact on variability on the biopsy specimen interpretation.
Follow-up
3 years following lung transplantation.
CET Conclusions
This is an interesting report looking at 481 transbronchial biopsy specimens that were graded by the local pathologist and central pathologist. Using the International Society of Heart and Lung Transplantation grading for acute rejection there was an overall concurrence rate of 74% and 89% respectively for grade A and grade B biopsies respectively. The biopsy specimens were from the AIRSAC trial and the results show that there is considerable interobserver variability in grading of transbronchial biopsy specimens after lung transplantation.
Trial registration
ClinicalTrials.gov – NCT00321906