CCTC - Certified Clinical Transplant Coordinator Pre-Transplant Candidate Evaluation Questions and Answers — Questions and Answers
Question 1: A 58-year-old male with end-stage renal disease is undergoing evaluation for kidney transplantation. Which of the following is considered an absolute contraindication to proceeding with the transplant?
- A body mass index (BMI) of 38 kg/m²
- A history of well-controlled hypertension
- An active, untreated malignancy (Correct answer)
- A previous history of medication non-adherence
Correct answer: An active, untreated malignancy
An active, untreated malignancy is an absolute contraindication for kidney transplantation. The required immunosuppressive therapy following transplant could accelerate cancer recurrence or metastasis. Other absolute contraindications include severe cardiac or pulmonary disease making surgery intolerable, active infection, and uncontrolled psychiatric disease. Morbid obesity, hypertension, and a history of non-adherence are typically considered relative contraindications that require management and careful consideration.
Question 2: During the pre-transplant psychosocial evaluation, which domain is assessed to determine the candidate's ability to manage the complex post-transplant medication regimen and follow-up appointments?
- Social support system
- Psychological health and stability
- Lifestyle and substance use history
- Health literacy and adherence potential (Correct answer)
Correct answer: Health literacy and adherence potential
The psychosocial evaluation assesses multiple domains, but the candidate's health literacy and potential for adherence are specifically evaluated to gauge their ability to understand and follow the complex medical regimen required after transplantation. This includes managing medications, attending appointments, and monitoring their health. While social support, psychological health, and substance use history are also critical components of the overall assessment, they do not as directly address the cognitive and behavioral capacity for medical management.
Question 3: A potential liver transplant candidate has a history of significant coronary artery disease (CAD). As part of the cardiac evaluation, which of the following is a primary goal?
- To ensure the patient can tolerate a post-transplant exercise regimen.
- To determine the patient's long-term risk for cardiac events post-transplantation. (Correct answer)
- To obtain a baseline electrocardiogram (ECG) for future comparison only.
- To rule out any need for lifelong cardiac medications after transplant.
Correct answer: To determine the patient's long-term risk for cardiac events post-transplantation.
Cardiovascular disease is a leading cause of morbidity and mortality after liver and kidney transplantation. A primary goal of the pre-transplant cardiac evaluation is to perform a global assessment for both short- and long-term risk for major adverse cardiac events (MACE). This involves risk stratification that considers both the anatomic and functional consequences of CAD to ensure the candidate can survive the surgery and has a good long-term prognosis.
Question 4: Which of the following immunological tests is performed to determine a transplant candidate's sensitization to a broad panel of potential donor antigens?
- ABO blood typing
- Human Leukocyte Antigen (HLA) typing
- Panel Reactive Antibody (PRA) screening (Correct answer)
- Cytomegalovirus (CMV) serology
Correct answer: Panel Reactive Antibody (PRA) screening
Panel Reactive Antibody (PRA) screening is used to test the recipient's serum for antibodies against a panel of cells representing the general donor population. A high PRA indicates a high degree of sensitization, which can make finding a compatible donor more difficult and increases the risk of rejection. HLA typing identifies the specific antigens of the recipient, ABO typing determines blood group compatibility, and CMV serology checks for past exposure to cytomegalovirus.
Question 5: A 45-year-old female is being evaluated for a lung transplant. Her infectious disease screening comes back positive for latent tuberculosis infection (LTBI) via a PPD skin test, with a negative chest X-ray. What is the most appropriate next step?
- Immediately list her for transplant as she has no active disease.
- Permanently disqualify her from transplant consideration.
- Initiate treatment for LTBI before or after transplantation. (Correct answer)
- Repeat the PPD test in three months to confirm the result.
Correct answer: Initiate treatment for LTBI before or after transplantation.
Active infection is an absolute contraindication, but latent infection is not. For candidates with LTBI, the standard of care is to consider prophylactic therapy (e.g., with isoniazid) to prevent reactivation of the disease after post-transplant immunosuppression is initiated. The decision on the timing of treatment (before or after transplant) depends on the individual's clinical situation. Disqualification is not necessary, and waiting to repeat the test would cause an unnecessary delay.
Question 6: In evaluating a candidate for kidney transplantation, which of the following findings is considered a relative contraindication that requires careful assessment and management rather than an absolute one?
- Uncontrolled sepsis
- Severe, irreversible cardiac disease
- Morbid obesity (BMI > 40 kg/m²) (Correct answer)
- Metastatic lung cancer
Correct answer: Morbid obesity (BMI > 40 kg/m²)
Morbid obesity is generally considered a relative contraindication to transplantation. While it increases surgical risk and can impact graft function, it may be managed through weight loss programs before transplant. In contrast, active infections like uncontrolled sepsis, active malignancies, and severe, uncorrectable cardiopulmonary disease are considered absolute contraindications because they pose an unacceptably high risk of mortality or immediate graft failure.
CCTC - Certified Clinical Transplant Coordinator Pre-Transplant Candidate Evaluation Questions and Answers
A 58-year-old male with end-stage renal disease is undergoing evaluation for kidney transplantation.
Which of the following is considered an absolute contraindication to proceeding with the transplant?