KEYWORDS
Introduction
Methods
Literature level of evidence A: data derived from multiple RCTs or meta-analyses B1: data derived from 1 RCT B2: data derived from large non-randomized studies C1: data derived from small studies, retrospective studies, or registries C2: expert opinion, no published data |
Strength of survey agreement (S) S1: excellent: 81%–100% S2: good: 61%–80% S3: moderate: 41%–60% S4: fair: 21%–40% S5: poor: <20% |
Strength of subgroup opinion (O) OI: strong OII: moderate OIII: weak |
Strength of workforce agreement based on Delphi voting (V) % of workforce members who voted 8 or 9 out of 9 (i.e., high agreement) |
Statements
1. Bronchoscopy procedure and BAL collection
1.1. Definitions
1.2. What are the indications for BAL in LTx?
Aslam S, Danziger-Isakov L, Luong ML, et al. Guidance from the International Society of Heart and Lung Transplantation regarding the SARS CoV-2 pandemic. Available at:https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf.
1.3. What is the optimal technique for performing BAL in LTx recipients?
2. Sample handling in the bronchoscopy department
3. Sample processing and testing for clinical purposes: microbiology
3.1. BAL clinical microbiologic studies
- Chambers DC
- Cherikh WS
- Goldfarb SB
- et al.
3.2. Laboratory processing of BAL samples in the microbiology lab for clinical purposes
Variable | Micro lab | Cytology lab | Research lab |
---|---|---|---|
Identifying information (name, medical record number, date of birth) | Yes | Yes | — |
Patient/sample research ID | — | — | Yes |
Patient consent | — | — | Yes |
Lung transplant status | Yes | Yes | Yes |
General clinical information | Yes | Yes | — |
Tests requested | Yes | Yes | — |
Sex | — | — | Yes |
Age | — | — | Yes |
Native lung disease | — | — | Yes |
Ethnicity | — | — | Yes |
Date of transplant | — | Yes | Yes |
Type of transplant | — | — | Yes |
Date of bronchoscopy | Yes | Yes | Yes |
Indication for bronchoscopy | Yes | Yes | Yes |
Performed procedures | — | — | Yes |
Location of BAL | Yes | — | Yes |
Volume instilled | — | — | Yes |
Return volume | — | — | Yes |
4. Sample processing and testing for clinical purposes: cytology
4.1. BAL clinical cytological and cell count studies
Microscopic cytology examination:
Cell counts:
- Tikkanen J
- Lemström K
- Halme M
- Pakkala S
- Taskinen E
- Koskinen P
4.2. Techniques for cytological studies of BAL samples
- Tikkanen J
- Lemström K
- Halme M
- Pakkala S
- Taskinen E
- Koskinen P
5. BAL sample processing and testing for research
Introduction: What can and is being done with BAL fluid for research purposes?
5.1. How should BAL for research be done?
Variable | Reported in previous papers | Recommended minimum required information |
---|---|---|
Bronchoscopy | ||
Time post-transplant | 61.3% | Yes |
Route of bronchoscopy | 14.3% | — |
Other procedures | 48.4% | Yes |
Sequence of procedures | 16% | — |
Sample collection procedure | ||
Rinsing of bronchoscope | 1.7% | — |
Location of sampling | 42.1% | Yes |
Volume instilled | 51.8% | Yes |
Number of aliquots | 40.4% | Yes |
Dwell time | 5.5% | — |
Information on suction | 16% | — |
Sample storage and processing after collection | ||
Pooling of BAL | 25.1% | Yes |
Storage between collection and processing | 24.2% | Yes |
Storage of unprocessed (raw) BAL | 11% | Yes |
BAL cell pellet preservation | 22.9% | Yes |
BAL supernatant processing | 25% | Yes |
Centrifugation conditions | 29% | Yes |
Processing of sample in lab | 42.7% | Yes |
Storage after processing | 23.4% | Yes |
Quality assessment | 4.2% | Yes |
Normalization of sample | 4.4% | Yes |
5.2. What are common practices for handling collected BAL for research?
5.3. What are the recommendations for normalization of BAL analytes, storage, and quality control?
6. BAL microbiome analysis for research
6.1. Are there special considerations for BAL collection and processing, relating to potential downstream use for microbiome studies?
6.2. How should BAL for microbiome analysis be fractionated/processed before storage, if at all?
6.3. How should BAL fluids be stored for later microbiome analysis?
7. Sample inventory/tracking and linkage among clinical and research samples and clinical data
7.1. What is the minimum information accompanying bio-banked/research samples?
7.2. How should samples be labeled and tracked for research purposes?
7.3. What are key pieces of information about the BAL collection that need to be reported in research manuscripts?
8. Donor bronchoscopy
8.1. What constitutes the minimum assessment of the donor airways?
8.2. How should sampling from donor airways be performed?
8.2.1. Approach to donor airway sampling for clinical purposes
8.2.2. If donor airway samples are collected for research, should the sampling be altered?
8.2.3. Are there special considerations in the context of clinical ex vivo lung perfusion (EVLP)?
8.2.4. How should the airway samples be transported from the donor to the recipient hospital?
8.3. What clinical studies should be ordered on the airway samples obtained from donors?
9. Pediatric-specific considerations
9.1. Indications and contraindications for BAL sampling in children after LTx
9.2. Methods for performing BAL in children after LTx
9.3. Analysis of BAL in pediatric lung transplant recipients
9.4. Analysis of BAL and BW in pediatric lung donors
Conclusion
Members of the Workforce
Disclosure statement
Appendix. Supplementary materials
References
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