Workup
Laboratory Studies
Pretransplant laboratory values must be determined to evaluate the appropriateness of the candidate for transplantation. The following are the laboratory tests:
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HIV, hepatitis B, hepatitis C, toxoplasmosis, cytomegalovirus (CMV), and Epstein-Barr virus (EBV) serologies
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Liver function tests
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Creatinine and 24-hour creatinine clearance
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Complete blood count
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Chemistry panel
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Human leukocyte antigen (HLA) phenotype and panel-reactive antibody (PRA) level
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Cotinine level
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Room air blood gas
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Coagulation profile
Next:
Imaging Studies
The pretransplant workup includes the following studies:
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High-resolution chest computed tomographic (CT) scan
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Echocardiogram
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Right and left heart catheterization
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Quantitative lung perfusion scan
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Mammogram
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Pap smear/prostate-specific antigen (PSA) assay
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Bone density study
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Pulmonary function tests with a 6-min walk
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Bronchoscopy
Previous
Media Gallery
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This chest radiograph performed 24 hours following right unilateral lung transplantation is within normal limits.
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Seventy-two hours following lung transplantation, this patient developed dyspnea and hypoxemia. The bronchoscopy and bronchoalveolar lavage revealed no evidence of bacterial infection. The likely cause of this deterioration is reperfusion/reimplantation response.
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A 19-year-old woman had living donor transplantation. She developed pulmonary artery stenosis several months later. This was treated with a pulmonary artery stent. Courtesy of A. Szabo, RN.
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This patient developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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Lateral chest radiograph on a patient who developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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The CT scan of the chest of a patient with confirmed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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A 34-year-old man developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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Lateral radiograph of a 34-year-old man who developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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The high-resolution CT scan showing findings of branchio-otorenal (BOR) syndrome following bilateral lung transplantation (BLT).
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Bronchopleural fistula following right pneumonectomy and left single-lung transplantation (SLT).
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Severe acute rejection within 10 days of lung transplantation (lower magnification). The typical histological findings are perivascular lymphocytic infiltrates. Courtesy of Zhaolin Xu, MD.
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Severe acute rejection within 10 days of lung transplantation (high power). Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the low-power field, which is indicating acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the high-power field, which indicates acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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Bronchial anastomosis. Posterior wall closure is performed with a continuous suture.
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Right atrial anastomosis. Continuous anastomosis with the common pulmonary vein joined to the atrium.
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Completed atrial anastomosis.
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Donor lung showing hilar surface.
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The clamps are exposing the donor vein.
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Donor bronchus, artery to the right and vein to the left.
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Right donor bronchus.
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A close-up shot of the donor vein.
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Bilateral lung transplantation to treat cystic fibrosis in a 23-year-old woman. Anteroposterior (AP) chest radiograph shows mild edema in the right perihilar region soon after surgery; this finding is consistent with an implantation response.
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Anteroposterior (AP) chest radiograph obtained the following day shows increased edema.
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Bilateral lung transplants in 23-year-old woman who developed infection at the bronchial anastomoses. CT scan shows right bronchial stenosis (arrow).
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CT image shows left bronchial stenosis (arrow).
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Posteroanterior (PA) chest radiograph in a 23-year-old woman who underwent bilateral lung transplantation because of cystic fibrosis. Image shows left upper-lobe collapse. Bilateral bronchial stents are in place.
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Lateral radiograph shows left upper-lobe collapse. Arrow points to a bronchial stent. Bronchoscopy showed that scar tissue obliterated the orifice to the left upper-lobe bronchus.
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CT image in a 61-year-old-woman with a single-lung transplant for emphysema with Aspergillus infection. Image shows an ill-defined nodule in the right upper lobe with a surrounding halo of ground-glass opacity (arrow), a finding virtually diagnostic of Aspergillus infection in the correct clinical setting.
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Aspergillus infection 61-year-old man with a left lung transplant because of idiopathic pulmonary fibrosis. Frontal chest radiograph shows a normal left (transplant) lung and lower-lobe consolidation in the right (native) lung.
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CT of patient shows patchy areas of consolidation in the right lower lobe and a clear left lung. Biopsy showed Aspergillus infection.
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Cytomegaloviral (CMV) infection in a 52-year-old man with a right lung transplant because of emphysema. Frontal chest radiograph shows right lower-lobe and left mid-lung consolidation and a small right pleural effusion. Note that the less-compliant transplant lung pulls the mediastinum to the right.
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CT of patient with cytomegaloviral (CMV) pneumonia shows patchy consolidation, greater on the right (transplant lung) than on the left, and a right pleural effusion.
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Chest radiograph in bilateral lung transplant recipient showing bilateral pneumothoraces (arrows).
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CT shows pneumothorax in common pleural space (arrow).
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Lung carcinoma in lung transplant recipient. PA chest radiograph shows a spiculated nodule in the lower lobe of the native right lung.
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Primary lung carcinoma in lung transplant recipient. CT scan of patient with previous radiograph shows spiculated nodule in the lower lobe of the emphysematous native right lung (arrow).
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Post-transplant lymphoproliferative disorder in double lung transplant recipient. Contrast-enhanced CT scan shows low attenuation mass (arrow) in the anterior mediastinum.
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