Lung Conditions, Diagnostics & Treatments
Excellence and Innovation in Lung Transplantation
For patients with severe lung diseases such as emphysema, cystic fibrosis, pulmonary fibrosis and pulmonary hypertension, lung transplantation may be a viable option.
In 1988, Cedars-Sinai Medical Center opened the first lung transplantation program of its kind in the western U.S. Today, lung transplants at Cedars-Sinai are done under the multidisciplinary partnership of the Cedars-Sinai Comprehensive Transplant Center.
The Women's Guild Lung Transplant Center treats patients with following severe lung diseases:
Diagnostic Imaging & Testing
People who are being considered for a lung transplant or a heart and lung transplant go through a number of tests. These tests range from simple, common ones like blood tests to sophisticated imaging techniques. The purpose of these tests is to:
- Give the transplant team detailed information about the patient's condition
- Make sure the patient doesn't have cancer or other conditions that might make a lung transplant unsuccessful
- Collect information needed to get the best match between the person receiving new organs and the donor
A lung transplant (or heart and lung transplant) can only be successful if the blood and tissue type of the organ donor and the organ recipient match. The onsite Immunogenetics and Transplantation Laboratory at Cedars-Sinai provides state-of-art blood and tissue typing and human leukocyte antigent (HLA) sensitivity analysis.
Blood Typing and Compatibility
All people fit into one of four blood types—A, B, AB and O. Everyone is compatible with some blood types but not all of them as follows:
- People with blood type A are compatible with donor organs (or blood) from a person with type A or O blood.
- People with blood type B are compatible with blood type B or O
- People with blood type AB are compatible with blood types A, B, AB or O. They are known as universal recipients.
- People with blood type O are compatible only with organs or blood donated by another type O person. People with type O blood are known as universal donors because all blood types are compatible with type O blood.
If a person receives a lung or a heart from someone with an incompatible blood type, his or her body will recognize the organ as foreign and destroy it.
Tissue Typing and Compatibility
One of the tools the body uses to fight invading foreign substances is human leukocyte antigen (HLA). HLA consists of proteins that regulate the way the body recognizes foreign substances. In HLA-sensitized organ recipients, the patient has developed antibodies to the potential donor's HLA. If an HLA incompatible transplant were to take place, the recipient's immune system would attack the HLA-bearing cells in the donor organ. This would cause the transplanted organ to fail.
People can become sensitized by exposure to foreign substances. This can happen during pregnancy, when a woman is exposed to the foreign tissue from her fetus or through previous organ transplants or blood transfusions.
Imaging tests use various ways of creating pictures of the inside of the body. Some, like X-rays, are familiar to most people. Others use sophisticated, computer-assisted techniques to create highly detailed images of the inside of the body.
Because of the close relationship between the heart and lungs, a doctor may do imaging scans on a patient's heart as well as lungs.
Imaging tests include:
- Chest X-rays can show infections, a collapsed lung, overinflation of the lung or tumors.
- Computerized tomography (CT) scans show details of the chest that can't be seen on an X-ray. Sometimes a material is used to create contrast when the scan is done so that certain features will show up more clearly. A CT scan takes about an hour to do. A person should not eat before having a CT scan.
- Echocardiogram (ECHO) is a type of image created by sound and its echoes in the body. An echocardiogram is done to see what impact lung disease has had on the heart. It can also give information about the blood pressure inside the arteries of the lung. This test takes about 30 minutes.
- Electrocardiogram (EKG) records the electrical activity of the heart. This 15-minute test gives doctors information about the heart's rate and rhythm as it pumps.
- Stress myocardial perfusion imaging test uses small amount of radioactive materials to create an image of the blood flow to the heart muscles.
- Additional tests may be required not listed
Among the most basic tests done during an evaluation for lung transplantation is a blood test. A blood test is simple. It takes about 15 minutes and requires only that blood be drawn from a vein. It is best done after not eating or drinking anything for about 12 hours before the test.
A blood test gives the doctor information such as blood chemistry values. This includes measuring the amounts of potassium, sodium, cholesterol, triglycerides, liver function enzymes and electrolytes. It also shows whether or not there is an infection in the body, including herpes simplex, HIV/AIDS, hepatitis, Epstein-Barr or other viruses. A blood test also shows whether a person is anemic. Anemia affects how much oxygen the blood can carry.
Men over the age of 40 will be given a PSA test to check for signs of prostate cancer. Women over the age of 40 will need a mammogram if they haven't had one in the past year. Women will also need a gynecological evaluation and PAP, if they haven't had one in the past year.
A colonoscopy or a sigmoidoscopy may also be needed if the patient hasn't had one within the recommended interval.
Urine tests will be given to check on how well the kidneys are working. A stool test to check for bleeding in the intestines may also be done.
Another test that is done for lung patients is measuring arterial blood gases. This five-minute test involved putting a needle into an artery in the wrist. It measures the amount of oxygen the blood is able to carry to body tissues.
Potential candidates for lung or heart and lung transplantation will also be given tests for tuberculosis and Valley fever.
Pulmonary function tests measure how your lungs work. They measure airflow through the lungs, how much air the lungs can take in and how quickly oxygen gets into the blood. These may show symptoms of lung disease, how well treatment is working and how well the body is responding to treatment.
The pulmonary function tests that may be done when a person is being evaluated for a lung or a heart-lung transplant include:
- Spirograms, which measure airflow. They are used to see if a patient has diseases such as asthma that block the flow of air inside the lungs. This test is done by having the patient blow into a testing device as rapidly and hard as possible for as long as possible. This is done twice to get an accurate measurement. If the test comes out abnormal, it may be done again using a medicine to open up the air passages of the lungs. If there is improvement in the measure, the patient may benefit from more medicine rather than lung transplantation.
- Lung volume test, which measures how much air the lung can hold. The patient breathes a special mixture of gases at a normal rate for about three minutes. Then he or she slowly exhales. Using the measurements gained from the test and mathematical formulas, the doctor can estimate the amount of gas the lung can hold. If the measurement shows that lung volume is low, the patient may have a disease such as pulmonary fibrosis that interferes with the lung's ability to fill.
- Diffusion capacity, which measures the body's ability to take oxygen from the lungs. In this test, the patient exhales as completely as possible. Then he or she breathes in a special mixture of gases and holds the breath for about 10 seconds. The breath that is exhaled is collected in an airtight bag for analysis. One of the gases in the mixture is one that quickly moves from the airways of the lungs into the blood. The amount of the gas that remains in the bag, tells the doctor how well the blood is picking up the gas from the lungs. A person who has a low diffusion capacity may have advanced emphysema or pulmonary fibrosis.
- Ventilation perfusion scan, which compares the function of the right and left lungs. In this test, the patient is given a shot of a small amount of radioactive material. He or she is then asked to put on a face mask and breath in a radioactive gas, which spreads throughout the lungs. The gas is then exhaled normally. The radioactivity makes it easier for the doctors to see the flow of blood and gas throughout the lungs. It is normal to have less flow in the left lung because it is smaller. The test takes about an hour. Don't eat before taking the test.
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