eMedicine Specialties > Pediatrics: Surgery > Transplantation

Lung Transplantation: Workup

Author: Albert Faro, MD, Assistant Professor, Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine
Coauthor(s): Gary A Visner, DO, Chief, Division of Pediatric Pulmonology, Associate Professor, Department of Pediatrics, University of Florida College of Medicine
Contributor Information and Disclosures

Updated: May 30, 2008

Workup

Laboratory Studies

  • CBC count with differential - To establish baseline values and screen for underlying immunodeficiency
  • Prothrombin time (PT) and/or activated partial thromboplastin time (aPTT) - To detect abnormalities that may complicate surgery if untreated
  • Blood typing and screening - To match the donor and recipient
  • Renal disease battery - To detect adverse effects of calcineurin inhibitors and certain antimicrobial agents
  • Liver function tests and/or hepatitis battery - To assess for contraindications (ie, abnormal results) to lung transplantation
  • Preformed reactive antibody panel - To assess the risk of development of antibody-mediated rejection
  • Lipid profile - To detect adverse effects of certain immunosuppressant agents
  • Human immunodeficiency virus (HIV) venereal disease research laboratory (VDRL) test - To evaluate for a contraindication (ie, abnormal results) to lung transplantation
  • Immunoglobulin (Ig) G serologic tests for rubeola, rubella, herpes, Epstein-Barr virus (EBV), varicella, toxoplasmosis, and cytomegalovirus (CMV) - To screen for previous exposure and the need for vaccination when appropriate and to determine the risk of disease or its reactivation
  • Autoimmune screening for antinuclear antibodies (ANA), antinuclear cytoplasmic antibodies (ANCA), rheumatoid factor, and quantitative immunoglobulins (in specific patients)
  • ABG tests - To provide a measure of lung function
  • Thyroid profile

Imaging Studies

  • Chest radiography - To evaluate the extent of disease
  • ChestCT scanning - To evaluate the extent of disease and to determine the size of the thorax and vessels
  • Ventilation-perfusion scanning - To assist in determining the function of both lungs and, in a bilateral sequential procedure, to determine which lung should be replaced first
  • Echocardiography - To evaluate for pulmonary hypertension
  • SinusCT scanning - To determine the need for surgical intervention in patients with CF before transplantation (because the sinuses contain organisms that may reinfect the lower respiratory tract after transplantation)
  • Bone densitometry - To assess risk for fractures in patients with end-stage lung disease (These patients often have a history of steroid use and are at risk for fractures; measuring bone density allows for appropriate interventions to be put in place.)

Other Tests

  • Pulmonary function testing - To help determine the need for lung transplantation
  • Six-minute walk test - To help determine the need for lung transplantation
  • Sputum culture and susceptibilities - To direct the choice of antimicrobial agents after transplantation (Further susceptibility testing to determine combinations of antibiotics that may be synergistic may be necessary.)
  • Purified protein derivative (PPD) of tuberculin skin test - To rule out active tuberculosis, which is an absolute contraindication to lung transplantation
  • Electrocardiography - To screen for right ventricular hypertrophy or other cardiac dysfunction
  • Cardiac catheterization - In select cases to measure degree of pulmonary hypertension or to assess benefits of vasodilator therapy

Diagnostic Procedures

  • A lung biopsy should be considered if the diagnosis and prognosis remain unclear.
  • Bronchoscopy with bronchoalveolar lavage may be indicated to isolate pathogens from the lower airways or to document clearance of atypical mycobacteria.

More on Lung Transplantation

Overview: Lung Transplantation
Workup: Lung Transplantation
Treatment: Lung Transplantation
Follow-up: Lung Transplantation
Multimedia: Lung Transplantation
References
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References

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Further Reading

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Keywords

lung transplantation, lung transplant, lobar transplantation, living related donation, living-donor lung transplant, deceased donor lung transplant, heart-lung transplant, lung disease, end-stage lung disease, congenital lung disease, primary pulmonary hypertension, cystic fibrosis, CF, chronic lung disease, bronchiolitis obliterans, BO, congenital cardiac disease, pulmonary fibrosis, congenital heart disease, CHD, surfactant abnormalities, idiopathic pulmonary hypertension, idiopathic pulmonary hypertension, IPH, respiratory insufficiency, respiratory failure, syncope, diabetes mellitus, cor pulmonale, congenital alveolar proteinosis, pleurodesis

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Contributor Information and Disclosures

Author

Albert Faro, MD, Assistant Professor, Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine
Albert Faro, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Transplantation, and International Society for Heart and Lung Transplantation
Disclosure: Nothing to disclose.

Coauthor(s)

Gary A Visner, DO, Chief, Division of Pediatric Pulmonology, Associate Professor, Department of Pediatrics, University of Florida College of Medicine
Gary A Visner, DO is a member of the following medical societies: International Society for Heart and Lung Transplantation
Disclosure: Nothing to disclose.

Medical Editor

Richard G Ohye, MD, Director, Pediatric Cardiac Transplantation, Fellowship Program Director, Pediatric Cardiac Surgery, Assistant Professor, Department of Surgery, Section of Cardiac Surgery, University of Michigan Medical Center
Richard G Ohye, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, Association for Academic Surgery, International Society for Heart and Lung Transplantation, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Brian F Gilchrist, MD, Chief, Division of Pediatric Surgery, Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Ron Shapiro, MD, Professor of Surgery, University of Pittsburgh; Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center
Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons
Disclosure: Astellas Honoraria Speaking and teaching; Brystol Meyer Squibb StemCell Data Monitoring Committee Consulting fee Review panel membership

Chief Editor

Mary C Mancini, MD, PhD, Director of Cardiothoracic Transplantation, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

 
 
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