Transbronchial biopsy has eliminated the need for endomyocardial biopsy in heart-lung recipients.

Between April 1984 and August 1987, 27 patients have received heart-lung transplantations at Papworth Hospital. In the first 17 patients endomyocardial biopsies were performed routinely in accordance with the practice for heart transplant recipients. It became apparent that in contrast to heart transplant recipients, heart-lung transplant recipients show little evidence of cardiac rejection. As routine endomyocardial biopsies did not contribute therefore to patient management, they were stopped. Conversely, pulmonary rejection was diagnosed either clinically by a decrease in forced expired volume in 1 second (FEV1) in the absence of lung infection or by transbronchial biopsy, which determined when immunosuppression needed to be augmented. The presence of lung rejection was confirmed by resolution of the lung histopathology or improvement in FEV1.