Hematopoietic stem cell transplantation (HSCT) in the pediatric population is associated with pulmonary complications in 25% of recipients. The role of surgical lung biopsy (SLB) remains unclear because of concerns about both the therapeutic impact and morbidity associated with the procedure. A retrospective review of consecutive allogeneic HSCT recipients at Dana-Farber and Boston Children's Hospital Cancer and Blood Disorders Center between 2006 and 2016 was performed. All recipients who underwent SLB during the study period were identified and charts reviewed for perioperative complications, histopathologic findings, and changes in therapy delivered. Pearson's chi-square test and Student's t-test (or appropriate nonparametric test) were used to evaluate the associations between perioperative complication and categorical and continuous variables, respectively. Five hundred fifty-five HSCTs were included, among which 48 SLBs (8.6%) were identified. Median follow-up time was 24 months (range, 0 to 139). Thirty-day postoperative morbidity was 16.7% and 30-day postoperative mortality 10.4% (n = 5). The overall 30-day postoperative complication rate (including mortality) was 20.8% (n = 10). No mortalities were directly attributable to SLB. Definitive diagnoses were identified in 70.8% of SLBs (n = 34), and therapeutic changes occurred in 79.2% (n = 38). Overall, 83.3% of SLBs (n = 40) either provided a diagnosis or led to a change in therapy. SLB has an acceptable risk of perioperative complications in this medically complicated and often severely ill population. In most HSCT patients, SLB aids in defining the etiology of pulmonary infiltrates and can inform therapeutic decisions in patients where noninvasive diagnostic modalities have failed to provide a definitive diagnosis.

中文翻译：

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异基因造血干细胞移植后儿童肺活检的治疗效果和并发症。

小儿人群的造血干细胞移植（HSCT）与25％的接受者的肺部并发症相关。由于担心与手术相关的治疗效果和发病率，手术肺活检（SLB）的作用仍不清楚。回顾性回顾了2006年至2016年间在Dana-Farber和波士顿儿童医院癌症与血液疾病中心进行的同种异体HSCT接受者的回顾性研究。确定了研究期间所有接受SLB的接受者，并检查了围手术期并发症，组织病理学发现和所用治疗方法的变化。皮尔逊（Pearson）卡方检验和学生（Student）使用t检验（或适当的非参数检验）分别评估围手术期并发症与分类变量和连续变量之间的关联。纳入了55个HSCT，其中鉴定出48个SLB（8.6％）。中位随访时间为24个月（范围从0到139）。术后30天的发病率为16.7％，术后30天的死亡率为10.4％（n = 5）。术后30天的总并发症发生率（包括死亡率）为20.8％（n = 10）。没有死亡率直接归因于SLB。在70.8％的SLB中确定了明确的诊断（n = 34），在治疗上的改变发生在79.2％（n = 38）。总体而言，有83.3％的SLB（n = 40）提供了诊断或改变了治疗方法。在这个医学上复杂且往往是重病的人群中，SLB有围手术期并发症的可接受风险。在大多数HSCT患者中，SLB有助于确定肺部浸润的病因，并可以在非侵入性诊断方式未能提供明确诊断的患者中为治疗决策提供依据。