What is involved in the work-up prior to a lung transplant?
Before your child is accepted for lung transplantation, a careful and comprehensive evaluation is necessary. The evaluation is done on site at St. Louis Children’s Hospital. The process takes approximately 4 to 5 days and can be done inpatient or outpatient based on your child’s medical condition. The evaluation process involves many studies, the purpose of which is to:
- determine that no other medical or surgical therapy is possible and that lung transplantation remains your child’s only best option for survival.
- identify medical problems which would not benefit from lung transplantation, or pose to great a risk for transplantation.
- establish baseline medical, physical and psychological function for individuals who are candidates for lung transplantation. Many candidates will experience deterioration in function while waiting for transplantation.
- educate you and your child about lung transplantation.
The standard pre-transplantation evaluation includes:
- History and Physical Examination: Often by a number of physicians since St. Louis Children’s Hospital is a teaching institution.
- Blood Test: A number of blood samples are taken to evaluate your child’s liver, kidneys, blood counts, prior exposure to certain viruses, blood typing, and tissue typing.
- Pulmonary Function Testing: These tests are used to evaluate your child’s lungs and airways, and includes different breathing maneuvers such as: breathing deeply and rapidly, breathing out rapidly after taking a deep breath in, and breath holding. A sample of blood will be taken from the artery at your child’s wrist to measure oxygen and carbon dioxide levels (usually without oxygen supplementation). These tests will give us a baseline for your child’s lung disease and will be repeated at intervals before and after the lung transplant. After transplant, your child will be sent home with his/her own pulmonary function machine and will be expected to perform this important test twice a day initially and less frequently thereafter depending on clinical course.
- Infant Pulmonary Function Testing: This particular test is designed for the infants and young children who are unable to perform standard pulmonary function test due to age. Oral or intravenous sedation is required for this testing.
- Chest X-Ray: A standard view of the lungs, heart, and chest from frontal and lateral perspectives.
- CT Scan of the Chest: A special computerized x-ray of the chest which gives a more detailed, three dimensional picture of the lung tissue and the lining of the chest wall or pleura.
- Sinus CT Scan: For all CF patients in whom sinus disease with or without nasal polyps (benign growths) is almost universal and may require surgical drainage in the pre-transplant period .
- Physical Therapy Evaluation: Assessment of strength, posture, and stamina. A measure of walking capacity and oxygen level during six minutes of supervised ambulation is a particular useful test.
- RVG: A nuclear medicine study of the pumping chamber dimensions and strength of the heart. Requires intravenous injection, or the broviac may be used.
- Ventilation /Perfusion Scan: A nuclear medicine test which shows how much air (ventilation) and blood flow (perfusion) goes to each lung. A radioactive-labeled medication will be injected through a small intravenous catheter and pictures will be taken by a scanner. An intravenous injection is required or the broviac may be used.
- Electrocardiogram (EKG): This test records heart rhythm. It records how fast the heart is beating as well as any abnormal beats. Electrodes are placed on the chest, arms, and legs.
- Echocardiogram (ECHO): This test uses sound waves to look at heart size and how the muscle and valves are working. As the patient lies on a table, a technician moves the hand held device (transducer) over the chest which takes pictures and records the function of the heart.
- Cardiac Catheterization: Patients with pulmonary hypertension will require a cardiac catheterization. This test measures the specific pressures in the lungs and heart. After administering intravenous sedation, one of our pediatric cardiologist inserts a catheter (tube) into the large vein or artery in the groin and advances it into the heart. Pressures in the chambers of the heart are recorded. If the pressures are high, medication may be given to see if the pressures can be lowered. This procedure is done in the "Cath Lab" and takes about 1-2 hours. Your child will need to lie flat for a least 6 hours afterwards to prevent bleeding at the point where the catheter(s) was inserted.
- Transplant Education: Your family will meet with one of our transplant doctors and transplant nurses to educate you about lung transplant, and answer any additional questions. This will be done at the end of your evaluation but we encourage you to ask the transplant team questions during the course of your stay.
- Clinical Social Work Assessment: Your family will meet with our transplant social worker to review psychosocial issues and concerns, especially those which affect normal functioning and family issues.
- Financial Screening / Insurance Coverage: Lung transplantation is covered by most insurance companies and medical assistance programs. A SLCH advisor will assist you in determining how the surgery and long-term medications will be paid. This is done in a preliminary fashion prior to your child’s evaluation.
- Dietary Consultation: One of our experienced pediatric dietitians will perform an assessment of height, weight, and body muscle and fat stores as well as reviewing your child’s dietary history in detail. Your child’s nutritional status is important in maintaining health during the waiting period, lowering the risk of the surgery and speeding recovery after transplantation.
- Neurodevelopment Assessment: Your family will meet with one of our pediatric psychologists to review cognitive and emotional functioning of the child and family constellation. The stresses of lung transplantation make this an important and mandatory part of the evaluation. Please note that some insurers provide limited coverage for this testing.
- Child Life Services: One of the hospital’s child life specialist will meet you and your child and introduce you to their services which try to explain and brighten the often traumatic hospitalization experience.
- Additional studies may be required on an individual basis
What is involved in the work-up prior to a lung transplant?
Before your child is accepted for lung transplantation, a careful and comprehensive evaluation is necessary. The evaluation is done on site at St. Louis Children’s Hospital. The process takes approximately 4 to 5 days and can be done inpatient or outpatient based on your child’s medical condition. The evaluation process involves many studies, the purpose of which is to:
- determine that no other medical or surgical therapy is possible and that lung transplantation remains your child’s only best option for survival.
- identify medical problems which would not benefit from lung transplantation, or pose to great a risk for transplantation.
- establish baseline medical, physical and psychological function for individuals who are candidates for lung transplantation. Many candidates will experience deterioration in function while waiting for transplantation.
- educate you and your child about lung transplantation.
The standard pre-transplantation evaluation includes:
- History and Physical Examination: Often by a number of physicians since St. Louis Children’s Hospital is a teaching institution.
- Blood Test: A number of blood samples are taken to evaluate your child’s liver, kidneys, blood counts, prior exposure to certain viruses, blood typing, and tissue typing.
- Pulmonary Function Testing: These tests are used to evaluate your child’s lungs and airways, and includes different breathing maneuvers such as: breathing deeply and rapidly, breathing out rapidly after taking a deep breath in, and breath holding. A sample of blood will be taken from the artery at your child’s wrist to measure oxygen and carbon dioxide levels (usually without oxygen supplementation). These tests will give us a baseline for your child’s lung disease and will be repeated at intervals before and after the lung transplant. After transplant, your child will be sent home with his/her own pulmonary function machine and will be expected to perform this important test twice a day initially and less frequently thereafter depending on clinical course.
- Infant Pulmonary Function Testing: This particular test is designed for the infants and young children who are unable to perform standard pulmonary function test due to age. Oral or intravenous sedation is required for this testing.
- Chest X-Ray: A standard view of the lungs, heart, and chest from frontal and lateral perspectives.
- CT Scan of the Chest: A special computerized x-ray of the chest which gives a more detailed, three dimensional picture of the lung tissue and the lining of the chest wall or pleura.
- Sinus CT Scan: For all CF patients in whom sinus disease with or without nasal polyps (benign growths) is almost universal and may require surgical drainage in the pre-transplant period .
- Physical Therapy Evaluation: Assessment of strength, posture, and stamina. A measure of walking capacity and oxygen level during six minutes of supervised ambulation is a particular useful test.
- RVG: A nuclear medicine study of the pumping chamber dimensions and strength of the heart. Requires intravenous injection, or the broviac may be used.
- Ventilation /Perfusion Scan: A nuclear medicine test which shows how much air (ventilation) and blood flow (perfusion) goes to each lung. A radioactive-labeled medication will be injected through a small intravenous catheter and pictures will be taken by a scanner. An intravenous injection is required or the broviac may be used.
- Electrocardiogram (EKG): This test records heart rhythm. It records how fast the heart is beating as well as any abnormal beats. Electrodes are placed on the chest, arms, and legs.
- Echocardiogram (ECHO): This test uses sound waves to look at heart size and how the muscle and valves are working. As the patient lies on a table, a technician moves the hand held device (transducer) over the chest which takes pictures and records the function of the heart.
- Cardiac Catheterization: Patients with pulmonary hypertension will require a cardiac catheterization. This test measures the specific pressures in the lungs and heart. After administering intravenous sedation, one of our pediatric cardiologist inserts a catheter (tube) into the large vein or artery in the groin and advances it into the heart. Pressures in the chambers of the heart are recorded. If the pressures are high, medication may be given to see if the pressures can be lowered. This procedure is done in the "Cath Lab" and takes about 1-2 hours. Your child will need to lie flat for a least 6 hours afterwards to prevent bleeding at the point where the catheter(s) was inserted.
- Transplant Education: Your family will meet with one of our transplant doctors and transplant nurses to educate you about lung transplant, and answer any additional questions. This will be done at the end of your evaluation but we encourage you to ask the transplant team questions during the course of your stay.
- Clinical Social Work Assessment: Your family will meet with our transplant social worker to review psychosocial issues and concerns, especially those which affect normal functioning and family issues.
- Financial Screening / Insurance Coverage: Lung transplantation is covered by most insurance companies and medical assistance programs. A SLCH advisor will assist you in determining how the surgery and long-term medications will be paid. This is done in a preliminary fashion prior to your child’s evaluation.
- Dietary Consultation: One of our experienced pediatric dietitians will perform an assessment of height, weight, and body muscle and fat stores as well as reviewing your child’s dietary history in detail. Your child’s nutritional status is important in maintaining health during the waiting period, lowering the risk of the surgery and speeding recovery after transplantation.
- Neurodevelopment Assessment: Your family will meet with one of our pediatric psychologists to review cognitive and emotional functioning of the child and family constellation. The stresses of lung transplantation make this an important and mandatory part of the evaluation. Please note that some insurers provide limited coverage for this testing.
- Child Life Services: One of the hospital’s child life specialist will meet you and your child and introduce you to their services which try to explain and brighten the often traumatic hospitalization experience.
- Additional studies may be required on an individual basis
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