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    Papel da biópsia pulmonar cirúrgica no transplantado renal com doença respiratória
    (Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Tomotani, Daniere Yurie Vieira [UNIFESP]; Machado, Flavia Ribeiro Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study was to assess the role of surgical lung biopsy in determining the specific causative diagnosis in renal transplant patients with pulmonary disease of unknown cause and the complications related to this procedure. We conducted a single-center, retrospective study at Hospital do Rim e Hipertensão. From April 2010 to April in 2014, we included kidney transplant over 18 years-old admitted to the intensive care unit after elective surgical lung biopsy and those who underwent the procedure during admission to the intensive care unit because of acute respiratory failure. Were included 87 patients, 54 (62.1%) were admitted to the ICU after elective surgical biopsy. We obtained a specific histopathological diagnosis in 74 (85.1%) patients, 59 (67.8%) were infection. Fungi were the most common agents (37.9%), but tuberculosis was the most prevalent opportunistic infection (21.8%). Complications occurred in 28.7% of procedures, with persistent air leak being the most frequent (10.3%). A change in therapy was instituted in 46 patients (52.9%). The mortality rate was 25.3%. In the logistic regression analysis, risk factors associated with mortality were age (OR: 1.10 [95% CI: 1.03 to 1.18], p = 0.003), Simplified Acute Physiologic Score score 3 (SAPS 3) (OR: 1.10 [95% CI: 1.07 to 1.29], p <0.001) and the presence of complications directly related to the procedure (OR: 4.98 [95% CI: 1.22 to 20.32] p <0.025). In conclusion, surgical lung biopsy is a procedure that leads to a specific diagnosis in the majority of renal transplant recipients with pulmonary disease. However, it is not a harmless procedures as complications are frequent. Age, severity of disease and the postoperative complications were associated with a higher mortality.