Confocal Fluorescence Microscopy of the Human Airways in Diagnostics of Lung Transplantation

Bronchoscopy-guided tissue sampling is a central technique in many diseases including
diagnosing and staging lung cancers, diagnosing interstitial lung diseases, and acute and/or
chronic rejections following lung transplantation. Confocal fluorescence microscopy is a
novel technique used for in vivo microscopic imaging of proximal and distal airways including
bronchial and alveolar walls, microvessels, and inflammatory cells. We hypothesize that
confocal fluorescence microscopy images of bronchiolar and alveolar structures during
standard bronchoscopy could help recognize and classify the presence or absence of acute or
chronic rejection in lung transplant recipients.

The objectives and outcomes of this study are:

1. To assess the safety of confocal microscopy imaging in pediatric patients

2. To create diagnostic criteria for fibered confocal fluorescence microscopy image
interpretation of acute and chronic rejections following lung transplantation

3. To determine the sensitivity and specificity of confocal imaging in these patient groups
compared to the transbronchial biopsies

4. Correlate confocal images to FEV1 results

5. Correlate with CXRs and/or CT images

Inclusion Criteria:

- to be older than six years of age

- to be undergoing surveillance or clinically indicated bronchoscopies with
transbronchial biopsy as part of their routine care

- to be willing and able to comply with study procedures and provide written informed
consent/assent to participate in the study

Exclusion Criteria:

- to be unwilling to consent

- to be unable to safely tolerate a bronchoscopic procedure

- to have any contraindications to short-acting anesthetic agents

- to have any contraindications to transbronchial biopsies