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 doctorís 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.
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. Hereís how your blood type should be compatible with your
potential donorís 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 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:
- CMV IgM
- Skin tests for infection
- Metabolic panel
- CMV IgG
- Humoral immune panel
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.
Pulmonary function tests: Pulmonary function tests measure the capacity and function of
your lungs, as well as your bloodís 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 1Ĺ 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
- 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
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.
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 heartís 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 heartís 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 heartís 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 heartís movement. The echocardiogram provides pictures of the
heartís 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 heartís valves.
Additional tests for women
- pap test ó A routine test in which a sample is taken from the uterine wall to
check for abnormalities, such as pre-cancerous cells
- mammogram ó 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 ó A rectal exam to detect abnormal growths or changes (A blood
test known as the PSA is also done.)
- sigmoidoscopy ó 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 ó 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 bonesí 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 Teamís 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
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
- 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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