Protest Trial: TXA vs Saline

To determine if endobronchial (topical) tranexamic acid used prophylactically prior to performing transbronchial biopsies in lung transplant recipients reduces bleeding risk.

Inclusion Criteria: 1. Single or double lung transplant recipients 2. Patients \>18 years old 3. Willingness and ability to sign an informed consent for study participation Exclusion Criteria: 1. Platelet count (\1.6) 3. Active bleeding 4. Decompensated liver disease 5. History of uremic bleeding or BUN \>50 6. Severe pulmonary hypertension (mean PA pressure \>40 mmHg on RHC or estimated PA systolic pressure \>62 mmHg on TTE within one year of procedure) 7. Known bleeding disorder 8. Allergy to TXA 9. Prior history of severe TBBx-related airway bleeding requiring admission or advanced maneuvers for hemostasis (examples including intubation, bronchial artery embolization, surgical intervention) 10. Contraindications to topical TXA 11. Pregnancy 12. Vulnerable populations 13. Adults of limited English proficiency/non-English speakers