Supplementary Material for: Postmortem Biopsy to Obtain Lung Tissue in Congenital Diaphragmatic Hernia

<b><i>Background:</i></b> The accrual of human tissues from autopsies for diagnostic and translational research has decreased significantly over the last decades. <b><i>Objectives:</i></b> The objective of this study was to evaluate our experience with lung biopsy through a minithoracotomy as an alternative for obtaining postmortem tissue when full autopsy is refused in congenital diaphragmatic hernia (CDH) patients. <b><i>Methods:</i></b> Within 2 h of death we routinely asked parents for permission to perform an autopsy. Starting in 2001, parents who refused autopsy were asked permission for a postmortem lung biopsy. Pathology autopsy and biopsy reports were compared to clinical records. <b><i>Results:</i></b> Between 2001 and 2009, 46 patients died from CDH. Permission for autopsy was granted in 5 patients (11%). Of the remaining 41 patients, the parents of 15 (33%) agreed to postmortem lung biopsy. In all cases, additional findings were reported from the autopsy or biopsy, without changing the originally reported cause of death<i>.</i> In 1 case, we isolated fibroblasts from the lung biopsy using standardized cell culture techniques. Parents were able to take their child home with a minimal delay following biopsy. <b><i>Conclusions:</i></b> Parents refusing a full autopsy frequently agree to postmortem organ biopsy. This approach should therefore be considered as a valuable alternative, when permission for full autopsy is declined, for obtaining human tissues for both diagnostic and research purposes and is potentially applicable to other anomalies.

<b><i>研究背景：</i></b> 近数十年来，用于诊断与转化研究的尸检人体组织获取量已显著下降。<b><i>研究目标：</i></b> 本研究旨在评估我们采用经迷你开胸术的肺活检作为先天性膈疝（Congenital Diaphragmatic Hernia, CDH）患者拒绝全尸检时获取死后组织的替代方案的实践经验。<b><i>研究方法：</i></b> 我们会在患者死亡后2小时内常规征求其父母同意进行尸检。自2001年起，对于拒绝全尸检的父母，我们会征求其同意进行死后肺活检。将病理尸检报告与活检报告同临床记录进行比对分析。<b><i>研究结果：</i></b> 2001年至2009年间，共有46名先天性膈疝患者死亡。其中仅5名患者（占比11%）的家属同意进行全尸检。剩余41名患者中，有15名（占比33%）的家属同意进行死后肺活检。所有病例的尸检或活检均检出额外异常，但未改变最初报告的死亡原因。其中1例病例中，我们通过标准化细胞培养技术从肺活检组织中分离出了成纤维细胞。活检完成后，家属可在极小延迟的情况下将患儿遗体带回家中。<b><i>研究结论：</i></b> 拒绝全尸检的家属通常会同意进行死后器官活检。因此，当患者家属拒绝全尸检时，该方法可作为获取用于诊断与研究用途的人体组织的可靠替代方案，且该方法或可推广应用于其他先天畸形病例。