eMedicine Specialties > Transplantation > Surgery

Lung Transplantation: Workup

Author: Susan D Moffatt-Bruce, MD, PhD, FRCS(C), FACS, Assistant Professor, Division of Cardiothoracic Surgery, Department of Surgery, Assistant Professor, Department of Molecular Virology, Immunology and Medical Genetics, Surgical Director of Lung Transplantation, Deputy Director of Comprehensive Transplant Center, Ohio State University
Contributor Information and Disclosures

Updated: May 13, 2009

Workup

Laboratory Studies

Pretransplant laboratory values must be determined to evaluate the appropriateness of the candidate for transplantation. The following are the laboratory tests:

  • HIV, hepatitis B, hepatitis C, toxoplasmosis, cytomegalovirus (CMV), and Epstein-Barr virus (EBV) serologies
  • Liver function tests
  • Creatinine and 24-hour creatinine clearance
  • Complete blood count
  • Chemistry panel
  • Human leukocyte antigen (HLA) phenotype and panel-reactive antibody (PRA) level
  • Cotinine level
  • Room air blood gas
  • Coagulation profile

Imaging Studies

Pretransplant workup includes the following tests:

  • High-resolution chest computed tomographic (CT) scan
  • Echocardiogram
  • Right and left heart catheterization
  • Quantitative lung perfusion scan
  • Mammogram
  • Pap smear/prostate-specific antigen (PSA)
  • Colonoscopy
  • Bone density study
  • Pulmonary function tests with a 6-min walk
  • Bronchoscopy

More on Lung Transplantation

Overview: Lung Transplantation
Workup: Lung Transplantation
Treatment: Lung Transplantation
Follow-up: Lung Transplantation
Multimedia: Lung Transplantation
References
[ CLOSE WINDOW ]

References

  1. Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-fifth Official Adult Lung and Heart/Lung Transplantation Report-2008. J Heart Lung Transplant. 2008;27:957-969. [Medline].

  2. Demikhov VP. Experimental Transplantation of Vital Organs. New York: Consultants Bureau; 1962.

  3. Hardy JD, Eraslan S, Dalton ML Jr. Autotransplantation and homotransplantation of the lung: further studies. J Thorac Cardiovasc Surg. Nov 1963;46:606-15. [Medline].

  4. Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med. May 1 1986;314(18):1140-5. [Medline].

  5. Patterson GA, Cooper JD, Goldman B, et al. Technique of successful clinical double-lung transplantation. Ann Thorac Surg. Jun 1988;45(6):626-33. [Medline].

  6. Cooley DA, Bloodwell RD, Hallman GL. Organ transplantation for advanced cardiopulmonary disease. Ann Thorac Surg. 1969;8:300-302.

  7. Reitz BA, Wallwork JL, Hunt SA. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med. Mar 11 1982;306(10):557-64. [Medline].

  8. ASTP/ATS/ERS/ISHLT. International guidelines for the selection of lung transplant candidates. American Society for Transplant Physicians/American Thoracic Society/European Respiratory Society/International Society for Heart and Lung Transplantation. Am J Respir Crit Care Med. Jul 1998;158(1):335-9. [Medline].

  9. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. NEJM. 2004;350:1005-1012. [Medline].

  10. Mogulkoc N, Brutsche MH, Bishop PW, Greaves SM, Horrocks AW, Egan JJ; Greater Manchester Pulmonary Fibrosis Consortium. Pulmonary function in idiopathic pulmonary fibrosis and referral for lung transplantation. Am J Respir Crit Care Med. 2001;164:103-108. [Medline].

  11. Barst RJ, Rubin LJ, Long WA. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. The Primary Pulmonary Hypertension Study Group. N Engl J Med. Feb 1 1996;334(5):296-302. [Medline].

  12. Olschewski H, Walmrath D, Schermuly R. Aerosolized prostacyclin and iloprost in severe pulmonary hypertension. Ann Intern Med. May 1 1996;124(9):820-4. [Medline].

  13. Liou TG, Adler FR, Fitzsimmons SC. Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol. Feb 15 2001;153(4):345-52. [Medline].

  14. Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, et al. International Guidelines for the Selection of Lung Transplant Candidates: 2006 Update-A Consensus Report From the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006;25:745-755. [Medline].

  15. Meyers BF, Lynch JP, Battafarano RJ. Lung transplantation is warranted for stable, ventilator-dependent recipients. Ann Thorac Surg. Nov 2000;70(5):1675-8. [Medline].

  16. Low DE, Trulock EP, Kaiser LR. Morbidity, mortality, and early results of single versus bilateral lung transplantation for emphysema. J Thorac Cardiovasc Surg. Jun 1992;103(6):1119-26. [Medline].

  17. Hachem RR, Edwards LB, Yusen RD, Chakinala MM, Alexander Patterson G, Trulock EP. The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry. Clin Transplant. 2008;22:603-608. [Medline].

  18. Kobashigawa JA, Miller LW, Russell SD, Ewald GA, Zucker MJ, Goldberg LR, et al. Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant. 2006;6:1243-1245. [Medline].

  19. McNeil K, Glanville AR, Wahlers T, Knoop C, Speich R, Mamelok RD, et al. Comparison of mycophenolate mofetil and azathioprine for prevention of bronchiolitis obliterans syndrome in de novo lung transplant recipients. Transplantation. 2006;15:998-1003. [Medline].

  20. Groetzner J, Wittwer T, Kaczmarek I, Ueberfuhr P, Strauch J, Nagib R, et al. Conversion to sirolimus and mycophenolate can attenuate the progression of bronchiolitis obliterans syndrome and improves renal function after lung transplantation. Transplantation. 2006;81:355-360. [Medline].

  21. Snell GI, de Hoyos A, Krajden M. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest. Feb 1993;103(2):466-71. [Medline].

  22. Davis SQ, Garrity ER. Organ allocation in lung transplant. Chest. 2007;132:1646-1651. [Medline].

  23. Egan TM, Kaiser LR, Cooper JD. Lung transplantation. Curr Probl Surg. Oct 1989;26(10):673-751. [Medline].

  24. Marshall SE, Kramer MR, Lewiston NJ. Selection and evaluation of recipients for heart-lung and lung transplantation. Chest. Dec 1990;98(6):1488-94. [Medline].

  25. Meyers BF, Lynch J, Trulock EP. Lung transplantation: a decade of experience. Ann Surg. Sep 1999;230(3):362-70; discussion 370-1. [Medline].

  26. Egan TM, Detterbeck FC, Mill MR. Improved results of lung transplantation for patients with cystic fibrosis. J Thorac Cardiovasc Surg. Feb 1995;109(2):224-34; discussion 234-5. [Medline].

  27. Low DE, Trulock EP, Kaiser LR. Lung transplantation of ventilator-dependent patients. The Washington University Lung Transplantation Group. Chest. Jan 1992;101(1):8-11. [Medline].

  28. Detterbeck FC, Egan TM, Mill MR. Lung transplantation after previous thoracic surgical procedures. Ann Thorac Surg. Jul 1995;60(1):139-43. [Medline].

  29. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. Nov 13 1981;246(19):2184-6. [Medline].

  30. McWilliams TJ, Williams TJ, Whitford HM, Snell GI. Surveillance bronchoscopy in lung transplant recipients: risk versus benefit. J Heart Lung Transplant. 2008;27:1203-1209. [Medline].

  31. Stewart S, Fishbein MC, Snell GI, Berry GJ, Boehler A, Burke MM, et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection. J Heart Lung Transplant. 2007;26:1229-1242. [Medline].

  32. Knoop C, Haverich A, Fischer S. Immunosuppressive therapy after human lung transplantation. Eur Respir J. Jan 2004;23(1):159-71. [Medline].

  33. Dauber JH, Paradis IL, Dummer JS. Infectious complications in pulmonary allograft recipients. Clin Chest Med. Jun 1990;11(2):291-308. [Medline].

  34. Barr ML, Schenkel FA, Bowdish ME, Starnes VA. Living donor lobar lung transplantation: current status and future directions. Transplant Proc. Nov 2005;37(9):3983-6. [Medline].

  35. Starnes VA, Bowdish ME, Woo MS. A decade of living lobar lung transplantation: recipient outcomes. J Thorac Cardiovasc Surg. Jan 2004;127(1):114-22.

  36. Anthonisen NR. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. Am Rev Respir Dis. Sep 1989;140(3 Pt 2):S95-9. [Medline].

  37. Arcasoy SM, Kotloff RM. Lung transplantation. N Engl J Med. Apr 8 1999;340(14):1081-91. [Medline].

  38. Bando K, Armitage JM, Paradis IL. Indications for and results of single, bilateral, and heart-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg. Dec 1994;108(6):1056-65. [Medline].

  39. Brunsting LA, Lupinetti FM, Cascade PN. Pulmonary function in single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. May 1994;107(5):1337-44; discussion 1344-5. [Medline].

  40. Date H, Triantafillou AN, Trulock EP. Inhaled nitric oxide reduces human lung allograft dysfunction. J Thorac Cardiovasc Surg. May 1996;111(5):913-9. [Medline].

  41. Egan TM, Bennett LE, Garrity ER. Predictors of death on the UNOS lung transplant waiting list: results of a multivariate analysis. J Heart Lung Transplant. Feb 2001;20(2):242. [Medline].

  42. [Best Evidence] Fergusson DA, Hebert PC, Mazer CD, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. May 29 2008;358(22):2319-31. [Medline].

  43. Griffith BP, Hardesty RL, Armitage JM. A decade of lung transplantation. Ann Surg. Sep 1993;218(3):310-8; discussion 318-20. [Medline].

  44. Griffith BP, Hardesty RL, Trento A. Heart-lung transplantation: lessons learned and future hopes. Ann Thorac Surg. Jan 1987;43(1):6-16. [Medline].

  45. Hachem RR, Yusen RD, Chakinala MM, Meyers BF, Lynch JP, Aloush AA, et al. A randomized controlled trial of tacrolimus versus cyclosporine after lung transplantation. J Heart Lung Transplant. 2007;26:1012-1018. [Medline].

  46. Higenbottam T, Stewart S, Penketh A. Transbronchial lung biopsy for the diagnosis of rejection in heart-lung transplant patients. Transplantation. Oct 1988;46(4):532-9. [Medline].

  47. Kotloff RM, Zuckerman JB. Lung transplantation for cystic fibrosis: special considerations. Chest. Mar 1996;109(3):787-98. [Medline].

  48. Levine SM, Gibbons WJ, Bryan CL. Single lung transplantation for primary pulmonary hypertension. Chest. Nov 1990;98(5):1107-15. [Medline].

  49. Levine SM, Jenkinson SG, Bryan CL. Ventilation-perfusion inequalities during graft rejection in patients undergoing single lung transplantation for primary pulmonary hypertension. Chest. Feb 1992;101(2):401-5. [Medline].

  50. Levy NT, Liapis H, Eisenberg PR. Pathologic regression of primary pulmonary hypertension in left native lung following right single-lung transplantation. J Heart Lung Transplant. Mar 2001;20(3):381-4. [Medline].

  51. Macdonald P, Mundy J, Rogers P. Successful treatment of life-threatening acute reperfusion injury after lung transplantation with inhaled nitric oxide. J Thorac Cardiovasc Surg. Sep 1995;110(3):861-3. [Medline].

  52. Meyers BF, Lynch JP, Trulock EP. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience. J Thorac Cardiovasc Surg. Jul 2000;120(1):99-107. [Medline].

  53. Meyers BF, Lynch JP, Trulock EP. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience. J Thorac Cardiovasc Surg. Jul 2000;120(1):99-107. [Medline].

  54. Meyers BF, Yusen RD, Guthrie TJ. Outcome of bilateral lung volume reduction in patients with emphysema potentially eligible for lung transplantation. J Thorac Cardiovasc Surg. Jul 2001;122(1):10-7. [Medline].

  55. Montefusco CM, Veith FJ. Lung transplantation. Surg Clin North Am. Jun 1986;66(3):503-15. [Medline].

  56. Panos RJ, Mortenson RL, Niccoli SA. Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment. Am J Med. Apr 1990;88(4):396-404. [Medline].

  57. Pasque MK, Trulock EP, Kaiser LR. Single-lung transplantation for pulmonary hypertension. Three-month hemodynamic follow-up. Circulation. Dec 1991;84(6):2275-9. [Medline].

  58. Sanchez JL, Kruger RM, Paranjothi S. Relationship of cytomegalovirus viral load in blood to pneumonitis in lung transplant recipients. Transplantation. Aug 27 2001;72(4):733-5. [Medline].

  59. Schafers HJ, Wagner TO, Demertzis S. Preoperative corticosteroids. A contraindication to lung transplantation?. Chest. Nov 1992;102(5):1522-5. [Medline].

  60. Snell GI, Westall GP. Immunosuppression for lung transplantation: evidence to date. Drugs. 2007;67:1531-1539. [Medline].

  61. Sundaresan RS, Shiraishi Y, Trulock EP. Single or bilateral lung transplantation for emphysema?. J Thorac Cardiovasc Surg. Dec 1996;112(6):1485-94; discussion 1494-5. [Medline].

  62. Technique of successful clinical double-lung transplantation. Patterson G, Cooper J, Goldman B, Weisel RD, Pearson FG, Waters PF, Todd TR, Scully H, Goldberg M, Ginsberg RJ. Ann Thorac Surg. 1988;45:626-633. [Medline].

  63. Thabut G, Brugiere O, Leseche G. Preventive effect of inhaled nitric oxide and pentoxifylline on ischemia/reperfusion injury after lung transplantation. Transplantation. May 15 2001;71(9):1295-300. [Medline].

  64. Theodore J, Starnes VA, Lewiston NJ. Obliterative bronchiolitis. Clin Chest Med. Jun 1990;11(2):309-21. [Medline].

  65. Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. Toronto Lung Transplant Group. N Engl J Med. May 1 1986;314(18):1140-5. [Medline].

  66. Trulock EP. Lung transplantation for alpha 1-antitrypsin deficiency emphysema. Chest. Dec 1996;110(6 Suppl):284S-294S. [Medline].

  67. Trulock EP 3rd. Lung Transplantation for COPD. Chest. Apr 1998;113(4 Suppl):269S-276S. [Medline].

  68. Trulock EP, Egan TM, Kouchoukos NT. Single lung transplantation for severe chronic obstructive pulmonary disease. Washington University Lung Transplant Group. Chest. Oct 1989;96(4):738-42. [Medline].

  69. Vizza CD, Yusen RD, Lynch JP. Outcome of patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med. Sep 2000;162(3 Pt 1):819-25. [Medline].

  70. Watters LC, King TE, Schwarz MI. A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis. Am Rev Respir Dis. Jan 1986;133(1):97-103. [Medline].

  71. Whitehead B, Helms P, Goodwin M. Heart-lung transplantation for cystic fibrosis. 2: Outcome. Arch Dis Child. Sep 1991;66(9):1022-6; discussion 1016-7. [Medline].

  72. Yankaskas JR, Mallory GB. Lung transplantation in cystic fibrosis: consensus conference statement. Chest. Jan 1998;113(1):217-26. [Medline].

  73. Zuckermann A, Klepetko W. Use of cyclosporine in thoracic transplantation. Transplant Proc. Mar 2004;36(2 Suppl):331S-336S. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

lung transplantation, lung transplant, lung transplant pictures, lung pictures, advanced stage pulmonary disease, chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis (CF), immunosuppression, lung disease, lung disease treatment, lung pictures, lung transplant pictures, lung disease pictures, tacrolimus, FK-506, cyclosporine A, cyclosporin, rejection, organ rejection, lung transplant rejection, bronchiolitis obliterans syndrome, OKT3, ATG, antithrombocyte globulin, forced vital capacity, FVC, FEV1, forced expiratory volume, expiratory volume, pulmonary arterial hypertension, single-lung transplantation, SLT, bilateral sequential lung transplantation, double-lung transplantation, single-lung transplant, double-lung transplant, heart-lung transplant, PEEP, peak end expiratory pressure, DLT, lung surgery

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Susan D Moffatt-Bruce, MD, PhD, FRCS(C), FACS, Assistant Professor, Division of Cardiothoracic Surgery, Department of Surgery, Assistant Professor, Department of Molecular Virology, Immunology and Medical Genetics, Surgical Director of Lung Transplantation, Deputy Director of Comprehensive Transplant Center, Ohio State University
Susan D Moffatt-Bruce, MD, PhD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, American Thoracic Society, Central Surgical Association, International Society for Heart and Lung Transplantation, Ohio State Medical Association, Royal College of Physicians and Surgeons of Canada, Society of Thoracic Surgeons, Transplantation Society, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey C Milliken, MD, Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California at Irvine School of Medicine
Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, Southwest Oncology Group, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shreekanth V Karwande, MBBS, Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, Professor and Chief, Cardiothoracic Surgery, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.