The Evaluation Process

The Pediatric Lung Transplant Program offers a detailed approach towards the evaluation and selection of children for transplantation. Physicians, transplant nurse coordinators, social workers, counselors, and other professionals from different specialties at The Johns Hopkins Hospital assist in the evaluation and selection process. Ultimately, the surgical and medical co-directors of the Pediatric Lung Transplant Program make the decision for transplantation.

The evaluation process begins with the transplant pulmonologist obtaining a complete medical history and physical examination of your child. He or she will review all the available lab tests and x-rays. During this visit, the pulmonologist will determine if further evaluation for lung transplantation is appropriate. Additional testing will most likely be required as part of the evaluation. This testing requires several visits to The Johns Hopkins Hospital. Once the testing is complete the transplant surgeon will see your child

The evaluation process will review the function of your child’s major organs. The results of these tests will allow the transplant team to explore the medical and surgical risks of lung transplantation. The basic testing required for the evaluation process is described below. Additional studies may be required based on the results of these tests.

Pulmonary Function Tests (PFTs)
These tests measure the how well your child’s lungs are functioning. Your child will be asked to breathe into specialized machinery that determines the capacity and airflow within the lungs. An arterial blood gas (ABG) will also be obtained at the time of the PFTs. An ABG is performed by removing a small amount of blood from the artery in your child’s wrist to determine the amount of oxygen and carbon dioxide contained within.

Blood Tests
Your child will have blood tests to determine the how well his or her major organs (liver and kidneys) are functioning. In addition, your child’s blood type and exposure to several infections is determined. The initial blood tests required for the transplantation evaluation are:

• Complete blood count (CBC) (measures the number and type of blood cells)
• Electrolytes (measures the salts in the blood)
• Kidney and liver function tests
• Blood type
• Human immunodeficiency virus (HIV) test
• Antibody tests for infections [hepatitis, cytomegalovirus (CMV), varicella (chicken pox) and Ebstein Barr virus (EBV)].

Chest X-ray
Your child will need to have a standard chest X-ray during the evaluation.

Chest CT Scan
A chest CT scan is a computerized X-ray of your child’s chest that provides a more detailed view than standard X-rays. It will show the extent of lung disease present and provide an accurate estimate of lung size.

Ventilation-Perfusion (V/Q) Scan
This is a nuclear medicine test that measures the airflow (ventilation) and blood flow (perfusion) into the lungs. Children inhale a radiolabelled gas while a machine measures the distribution of the gas in their lungs. Then a radiolabelled medicine will be injected intravenously to determine the blood flow to each lung. Although this test is painless your child will need to lie still on a table for about 30-40 minutes during the testing.

Sinus CT Scan
Since all children with cystic fibrosis have some degree of sinus involvement, these children will need a CT scan of their sinuses to determine the extent of disease present.

Cardiac Evaluation                 

• Cardiology Consultation: A cardiologist will examine your child to determine how well his or her heart functions.
• Electrocardiogram (EKG): An EKG measures the electrical signals that the heart produces.
• Echocardiogram (Echo): An Echo is an ultrasound test that utilizes sound waves to view the chambers of the heart. This test shows how well your child’s heart is working.
• Cardiac Catheterization (Cardiac Cath): This test measures the heart function and the pressure in the heart and pulmonary blood vessels. Catheterization is performed by taking X-rays of the heart while dye is injected intravenously. This procedure is performed with sedation given by an anesthesiologist. Cardiac catheterization is performed by a specially trained pediatric cardiologist in a room designated as a “Cath Lab.” After the procedure your child will need to lie flat for 6 hours to prevent bleeding from the site of catheter insertion. This test is not required for most children undergoing lung transplantation, however, all children with pulmonary hypertension must have a cardiac catheterization during their evaluation.

Additional Consultations
Your child will have consultations with a nutritionist, social worker and physical therapist as part of the transplant evaluation.