{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:12:13Z","timestamp":1783131133212,"version":"3.54.6"},"reference-count":32,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Acute cellular rejection (ACR) is a complication after lung transplantation (LTx). The diagnosis of ACR is based on histologic findings using transbronchial forceps biopsy (FB). However, its diagnostic accuracy is limited because of the small biopsy size and crush artifacts. Transbronchial cryobiopsy (CB) provides a larger tissue size compared with FB. Methods: FB and CB were obtained consecutively during the same bronchoscopy (February 2020\u2013April 2021). All biopsies were scored according to the ISHLT criteria by three pathologists. Interobserver agreement was scored by the kappa index. We assessed the severity of bleeding and the presence of pneumothorax. Results: In total, 35 lung transplant recipients were included, and 126 CBs and 315 FBs were performed in 63 consecutive bronchoscopies. ACR (A1\u2013A3, minimal\u2013moderate) was detected in 18 cases (28.6%) by CB, whereas ACR was detected in 3 cases (4.8%) by FB. Moderate and severe bleeding complicated FB and CB procedures in 23 cases (36.5%) and 1 case (1.6%), respectively. Pneumothorax occurred in 6.3% of patients. The interobserver agreement was comparable for both CB and FB. Conclusions: CB provided an improved diagnostic yield for ACR diagnosis, leading to reclassification and changes in treatment strategies in 28.6% of cases. Prospective studies should better define the role of CB after LTx.<\/jats:p>","DOI":"10.3390\/life12060898","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T03:01:22Z","timestamp":1655348482000},"page":"898","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Transbronchial Cryobiopsy Compared to Forceps Biopsy for Diagnosis of Acute Cellular Rejection in Lung Transplants: Analysis of 63 Consecutive Procedures"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1561-2870","authenticated-orcid":false,"given":"Carolin","family":"Steinack","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Gaspert","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"},{"name":"Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorenza","family":"Gautschi","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1994-7443","authenticated-orcid":false,"given":"Ren\u00e9","family":"Hage","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6063-832X","authenticated-orcid":false,"given":"Bart","family":"Vrugt","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cantonal Hospital M\u00fcnsterlingen, 8596 M\u00fcnsterlingen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Soltermann","sequence":"additional","affiliation":[{"name":"Pathology L\u00e4nggasse, 3063 Ittigen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5404-7566","authenticated-orcid":false,"given":"Mac\u00e9 Matthew","family":"Schuurmans","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Franzen","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.healun.2019.08.001","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match","volume":"38","author":"Chambers","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.healun.2019.03.009","article-title":"Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT","volume":"38","author":"Verleden","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"410","DOI":"10.21037\/atm.2020.02.127","article-title":"Surveillance for acute cellular rejection after lung transplantation","volume":"8","author":"Greer","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kaes, J., Van Der Borght, E., Vanstapel, A., Van Herck, A., Sacreas, A., Heigl, T., Vanaudenaerde, B.M., Godinas, L., Van Raemdonck, D.E., and Ceulemans, L.J. (2020). Peripheral Blood Eosinophilia Is Associated with Poor Outcome Post-Lung Transplantation. Cells, 9.","DOI":"10.3390\/cells9112516"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12931-016-0391-y","article-title":"Diagnostic value of plasma and bronchoalveolar lavage samples in acute lung allograft rejection: Differential cytology","volume":"17","author":"Speck","year":"2016","journal-title":"Respir. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12931-017-0634-6","article-title":"Plasma and bronchoalveolar lavage samples in acute lung allograft rejection: The potential role of cytokines as diagnostic markers","volume":"18","author":"Speck","year":"2017","journal-title":"Respir. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.healun.2019.05.001","article-title":"Usefulness of gene expression profiling of bronchoalveolar lavage cells in acute lung allograft rejection","volume":"38","author":"Weigt","year":"2019","journal-title":"J. Hearth Lung Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.healun.2019.06.016","article-title":"Rethinking bronchoalveolar lavage in acute cellular rejection: How golden is the standard of transbronchial biopsies?","volume":"38","author":"Koutsokera","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.healun.2007.10.017","article-title":"Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection","volume":"26","author":"Stewart","year":"2007","journal-title":"J. Heart Lung Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/crj.12207","article-title":"Transbronchial lung biopsy: The pathologist\u2019s point of view","volume":"10","author":"Pourabdollah","year":"2016","journal-title":"Clin. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000135934","article-title":"Old Meets Modern: The Use of Traditional Cryoprobes in the Age of Molecular Biology","volume":"76","author":"Hetzel","year":"2008","journal-title":"Respiration"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1177\/000348947608500518","article-title":"Transbronchoscopic cryosurgery of respiratory structures: Experimental and clinical studies","volume":"85","author":"Gorenstein","year":"1976","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1159\/000506017","article-title":"Evaluation of Efficacy of a New Cryoprobe for Transbronchial Cryobiopsy: A Randomized, Controlled in vivo Animal Study","volume":"99","author":"Hetzel","year":"2020","journal-title":"Respiration"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ravaglia, C., Wells, A.U., Tomassetti, S., Gurioli, C., Gurioli, C., Dubini, A., Cavazza, A., Colby, T.V., Piciucchi, S., and Puglisi, S. (2019). Diagnostic yield and risk\/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: A large cohort of 699 patients. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-0780-3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1164\/rccm.201807-1255ST","article-title":"Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline","volume":"198","author":"Raghu","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1159\/000484055","article-title":"Transbronchial Cryobiopsies for the Diagnosis of Diffuse Parenchymal Lung Diseases: Expert Statement from the Cryobiopsy Working Group on Safety and Utility and a Call for Standardization of the Procedure","volume":"95","author":"Hetzel","year":"2018","journal-title":"Respiration"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00408-013-9507-z","article-title":"Transbronchial Cryobiopsy in Immunocompromised Patients with Pulmonary Infiltrates: A Pilot Study","volume":"191","author":"Fruchter","year":"2013","journal-title":"Lung"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1183\/09031936.00033011","article-title":"Cryobiopsy increases the diagnostic yield of endobronchial biopsy: A multicentre trial","volume":"39","author":"Hetzel","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jtcvs.2009.12.028","article-title":"Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions","volume":"140","author":"Schumann","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000203987","article-title":"Transbronchial Cryobiopsy: A New Tool for Lung Biopsies","volume":"78","author":"Babiak","year":"2009","journal-title":"Respiration"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1016\/j.transproceed.2020.02.052","article-title":"Transbronchial Cryobiopsies in Lung Allograft Recipients for Surveillance Purposes: Initial Results","volume":"52","author":"Mohamed","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e13221","DOI":"10.1111\/ctr.13221","article-title":"Efficacy and safety of trans-bronchial cryo in comparison with forceps biopsy in lung allograft recipients: Analysis of 402 procedures","volume":"32","author":"Gershman","year":"2018","journal-title":"Clin. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"303","DOI":"10.5858\/arpa.2015-0294-OA","article-title":"Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?","volume":"140","author":"Roden","year":"2016","journal-title":"Arch Pathol. Lab. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1159\/000381921","article-title":"Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases","volume":"90","author":"Gershman","year":"2015","journal-title":"Respiration"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1378\/chest.12-2290","article-title":"Cryoprobe transbronchial lung biopsy in patients after lung transplantation: A pilot safety study","volume":"143","author":"Yarmus","year":"2013","journal-title":"Chest"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/resp.12037","article-title":"Transbronchial cryo-biopsy in lung transplantation patients: First report","volume":"18","author":"Fruchter","year":"2013","journal-title":"Respirology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/his.13656","article-title":"The role of transbronchial cryobiopsy in lung transplantation","volume":"73","author":"Montero","year":"2018","journal-title":"Histopathology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.chest.2020.01.036","article-title":"Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.transproceed.2020.02.029","article-title":"Surveillance Bronchoscopy in Lung Transplantation Recipients: A Single Center Experience Analysis","volume":"52","author":"Takizawa","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S1053-2498(01)00389-8","article-title":"Success of lung transplantation without surveillance bronchoscopy","volume":"21","author":"Valentine","year":"2002","journal-title":"J. Hearth Lung Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.healun.2020.07.010","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 37th adult heart transplantation report-2020; focus on deceased donor characteristics","volume":"39","author":"Khush","year":"2020","journal-title":"J. Heart Lung Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"106043","DOI":"10.1016\/j.rmed.2020.106043","article-title":"New opacities in lung allograft after transbronchial cryobiopsy","volume":"170","author":"Loor","year":"2020","journal-title":"Respir. Med."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/6\/898\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:32:23Z","timestamp":1760139143000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/6\/898"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,15]]},"references-count":32,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["life12060898"],"URL":"https:\/\/doi.org\/10.3390\/life12060898","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,15]]}}}