Pre-Transplant Candidate Evaluation Flashcards

A 58-year-old patient with end-stage renal disease has a panel reactive antibody (PRA) of 85%. What does this indicate for transplant planning?

Answer: The patient is highly sensitized and will have difficulty finding a compatible donor

A PRA of 85% means the patient has antibodies against 85% of the donor pool, making compatible organ matching significantly more difficult.

Which cardiac evaluation is typically required before listing a patient with diabetes mellitus for kidney transplantation?

Answer: Stress testing or coronary angiography to assess for occult coronary artery disease

Diabetic patients are at high risk for silent coronary artery disease, so functional stress testing or angiography is standard pre-listing cardiac evaluation.

A transplant candidate is found to have a positive PPD skin test with no prior BCG vaccination and no active symptoms. What is the appropriate management?

Answer: Prophylactic isoniazid (INH) therapy before and after transplant

Latent TB identified by positive PPD without prior BCG warrants prophylactic INH to prevent reactivation after immunosuppression.

During pre-transplant psychosocial evaluation, a candidate discloses ongoing alcohol use despite prior treatment. What is the transplant team's most appropriate next step?

Answer: Require a mandatory sobriety period and engagement with addiction treatment before listing

Most transplant programs require documented sobriety (typically 6 months) and active addiction treatment engagement before listing alcohol-dependent candidates.

Which finding on abdominal imaging would most concern the transplant team when evaluating a liver transplant candidate?

Answer: Portal vein thrombosis extending into the superior mesenteric vein

Extensive portal vein thrombosis involving the superior mesenteric vein significantly complicates liver transplant surgery and may be a contraindication.

A pre-transplant candidate has a BMI of 42 kg/m². How does this typically affect transplant listing decisions?

Answer: Morbid obesity is associated with increased perioperative risk and many centers require weight loss before listing

Morbid obesity (BMI ≥40) significantly increases surgical risk and many transplant centers require weight reduction to a safer BMI threshold before listing.

When performing a pre-transplant crossmatch, a T-cell flow cytometry crossmatch returns positive. What is the clinical implication?

Answer: The recipient has donor-specific antibodies against T-cell antigens, increasing hyperacute rejection risk

A positive T-cell flow crossmatch indicates donor-specific antibodies against HLA antigens on T cells, which is generally a contraindication to transplant due to rejection risk.