Lung transplant recipients undergo bronchoscopy with biopsies for clinical indications and for surveillance in the diagnosis of acute rejection using standard transbronchial forceps. It is recognized that standard forceps biopsies underestimate the presence or degree of airway rejection due to crush artifact and sample size. Transbronchial cryobiopsies have been shown in the literature to provide larger samples without crush artifact in a safe fashion in lung cancer patients. The aim of this study is to determine if transbronchial cryobiopsy is superior to standard transbronchial forceps biopsies in regards to sample size, architecture and the diagnosis of early rejection in lung transplant recipients which if discovered earlier may improve survival.

Inclusion Criteria:

• Individuals referred for either clinically indicated or surveillance flexible bronchoscopy will be included in the study population
• Age greater than 18 years and having undergone bilateral orthotopic lung transplantation

Exclusion Criteria:

• Coagulopathy: plts < 50,000 international normalized ratio (INR) > 1.5
• Forced expiratory volume at one second (FEV1) < 0.8
• Diffuse bullous disease
• Hemodynamic instability
• Severe hypoxemia