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Lung Transplant Evaluation: Required Tests

Why do I need to have pre-transplant evaluation tests?

Your pre-transplant evaluation includes a variety of medical tests that provide complete information about your overall health. The medical tests help the Lung Transplant Team identify any potential problems before the transplant surgery and avoid potential complications after the surgery.

Although each patient does not have the same tests, most of the tests included in this handout are common for all lung transplant patients. The tests required before the transplant are usually done on an outpatient basis and can be performed at your referring doctor’s office or at Cleveland Clinic. Your transplant coordinator will help arrange these tests for you. Please ask your transplant coordinator any questions you have about the tests you will need.

If special instructions are required before any of these tests, you will receive a written form that explains what to do before the tests.

Blood tests

Your health care provider or a technician will take a small sample of blood from your arm. The blood is sent to a lab where the following tests are performed:

Abo blood type: First, a simple blood test is performed to determine the blood type of the donor and recipient. Here’s how your blood type should be compatible with your potential donor’s blood type:

  • If you are blood type A, your donor should have blood type A or O.
  • If you are blood type B, your donor should have blood type B or O.
  • If you are blood type O, the donor must have blood type O. (A person with blood type O is called a universal donor because he or she can donate to someone of all blood types.)
  • If you have blood type AB (universal acceptor), your donor can have blood type AB, A, B, or O

Tissue typing: Tissue typing is a series of blood tests that evaluate the compatibility, or closeness, of tissue between the organ donor and recipient. From your blood samples, the tissue typing lab can identify and compare information about your antigens (the "markers" in cells that stimulate antibody production) so they can match a donor lung to you.

All donors are carefully screened to prevent any transmissible diseases or other complications.

Other blood tests: In the laboratory, an additional series of tests will be performed to detect certain substances in your blood and to evaluate your general health. These blood tests might include:

  • CEA
  • CMV IgM
  • CRP
  • Hepatitis
  • HIV
  • RPR
  • Skin tests for infection
  • Varicella
  • Metabolic panel
  • CMV IgG
  • EBV
  • Herpes
  • Humoral immune panel
  • Syphilis
  • Toxoplasmosis
  • WSR
  • TSH

Chest x-ray: A chest X-ray provides a picture of your heart and lungs. This X-ray provides information about the size of your heart and lungs, and the extent of your lung disease.

Lung tests

Pulmonary function tests: Pulmonary function tests measure the capacity and function of your lungs, as well as your blood’s ability to carry oxygen. During the tests, you will be asked to breathe into a device called a spirometer.

A complete set of pulmonary function tests lasts from 1½ to 2 hours. You will have time to rest briefly between tests.

You will need pulmonary function tests throughout your illness to:

  • Evaluate how your lungs process oxygen and carbon dioxide
  • Determine the severity of your lung disease
  • Determine how your lung disease is advancing (This is done by comparing test results from each pulmonary function test.)
  • Decide the best treatment for your lung disease

Here are some guidelines to follow before your scheduled pulmonary function tests:

  • Be sure to get plenty of sleep the night before your scheduled test.
  • Plan to wear loose clothing during the test so you can give your greatest breathing effort.
  • Limit your liquids and eat a light meal before the test. Drinking or eating too much before the test might make you feel bloated and unable to breathe deeply.

Ventilation perfusion scan: The ventilation perfusion scan provides information about the blood flow to your lungs and shows how much air each lung receives. This information helps the Lung Transplant Team decide which lung to transplant. A small amount of contrast material is injected into your vein so your doctor can see the blood flow through your lungs.

Computed tomography scan (ct scan): Computed tomography, commonly known as a CT scan, uses X-rays and computers to produce a detailed image of the lungs, showing their size and shape. Depending on the type of scan you need, a contrast material might be injected intravenously (into your vein) so the radiologist can see the structure of your lungs.

A CT scan provides information about the extent of your disease and can reveal the presence of other diseases.

If you had a CT scan within 6 months before your pre-transplant evaluation, bring the CT scan films with you. You might not need to have the scan repeated.

Depending on your illness, your doctor might order other lung tests as indicated.

Heart tests

Because lung disease can affect your heart (especially the right side of your heart), you will need to have heart tests to identify and treat any potential problems before the transplant procedure.

Electrocardiogram: The electrocardiogram is used to evaluate your heart rhythm.

Before the test, electrodes (small, flat, sticky patches) are placed on your chest. The electrodes are attached to an electro-cardiograph monitor (EKG) that charts your heart’s electrical activity (heart rhythm).

Cardiac catheterization: Patients who are over 40 years of age, who have a history of heart disease, or a significant smoking history are required to have a cardiac catheterization.

Cardiac catheterization will help your doctors identify whether your coronary arteries are narrowed, whether your heart valves are working correctly, and whether the strength of your heart muscle is adequate. This procedure will help determine if you will need surgery before the transplant or special medicine after the transplant.

Cardiac catheterization is a procedure in which a cardiologist inserts a long, slender tube (called a catheter) through a blood vessel in the groin or arm and into the heart.

During a diagnostic procedure called coronary angiography, contrast material is injected through the catheter and into the heart. The contrast material is photographed as it moves through the heart’s chambers, valves, and major vessels.

From the photographs of the contrast material, the doctor can identify if there are any blockages in your heart valves.

Echocardiogram: An echocardiogram is a graphic outline of the heart’s movement. During the test, a wand or transducer is placed on your chest. The transducer emits ultrasound (high-frequency sound wave) vibrations so the doctor can see the outline of the heart’s movement. The echocardiogram provides pictures of the heart’s valves and chambers so the pumping action of the heart can be evaluated.

An echocardiogram is often combined with Doppler ultrasound to evaluate blood flow across the heart’s valves.

Additional tests for women

  • pap test — A routine test in which a sample is taken from the uterine wall to check for abnormalities, such as pre-cancerous cells
  • mammogram — An X-ray of the breast to detect abnormal growths or changes,or to provide a baseline reference for later comparison

Additional tests for men

  • prostate exam — A rectal exam to detect abnormal growths or changes (A blood test known as the PSA is also done.)

Other tests

  • sigmoidoscopy — This is a routine outpatient procedure in which the inside of the lower large intestine (called the sigmoid colon) is examined. Sigmoidoscopies are commonly used to evaluate bowel disorders, rectal bleeding, or polyps (usually benign growths).
  • bone densitometry — This is a test that quickly and accurately measures the density of bone. It is used primarily to detect osteopenia or osteoporosis, diseases in which the bones’ mineral content and density are low, and the risk of fractures is high.

During your pre-transplant evaluation appointment, the Lung Transplant Team will decide if you will need any additional tests after your appointment. Additional tests can be performed at Cleveland Clinic or in your home community. Your transplant coordinator will help you make these arrangements.

What happens after my pre-transplant evaluation?

At the end of your pre-transplant evaluation, and after the test results are complete, the Lung Transplant Team will meet to jointly discuss whether or not a lung transplant is the appropriate treatment for you. The transplant coordinator will then notify you of the Team’s decision.

Please understand that abnormal test results might require further investigation. The goal of pre-transplant testing is to ensure that you will be able to undergo the transplant surgery and recover without any significant risk of complications.

If you are approved and are going to be placed on the organ waiting list, the transplant coordinator will tell you what you need to do while you wait for your transplant.

References
  • National Heart, Lung, and Blood Institute. What Is a Lung Transplant?. www.nhlbi.nih.gov/. Accessed November 25, 2011.
  • UpToDate. Lung transplantation: Procedure and postoperative management. www.uptodate.com/. Accessed November 25, 2011.
  • American College of Chest Physicians and the Chest Foundation. A Guide to Lung Transplantation. www.chestnet.org/. Accessed November 25, 2011.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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