Pre-Transplant Candidate Evaluation Flashcards

A candidate for liver transplant has a MELD score of 28. What does this score primarily reflect?

Answer: The 90-day mortality risk from liver disease and urgency for transplantation

The MELD score (Model for End-Stage Liver Disease) estimates 90-day mortality from liver failure and is used to prioritize waitlist candidates by urgency.

Which cancer history is generally considered an absolute contraindication to solid organ transplantation?

Answer: Active metastatic malignancy with no curative treatment available

Active metastatic malignancy without curative options is an absolute contraindication because immunosuppression would accelerate tumor progression.

During nutritional assessment of a cirrhotic liver transplant candidate, severe sarcopenia is identified. Why is this clinically significant?

Answer: Sarcopenia is associated with increased waitlist mortality and worse post-transplant outcomes

Severe muscle wasting (sarcopenia) in cirrhotic patients is independently associated with higher waitlist mortality and increased post-transplant morbidity.

A patient being evaluated for heart transplant has been treated for non-Hodgkin's lymphoma and has been in remission for 3 years. What is the standard approach to this history?

Answer: Apply disease-free interval criteria (typically 2-5 years) and assess recurrence risk with oncology

Most centers apply disease-specific disease-free interval requirements and require oncology clearance; for lymphoma, 3 years may be acceptable depending on histology and risk.

A potential kidney transplant candidate has significant bilateral iliac artery calcification on CT imaging. Why is this relevant to transplant evaluation?

Answer: Severe vascular disease may prevent adequate arterial anastomosis for the transplanted kidney

Severe iliac artery calcification can compromise blood flow to the transplanted kidney and complicate surgical vascular anastomosis.

A transplant coordinator notes that a candidate's calculated GFR has been declining during the waitlist period. What action is most appropriate?

Answer: Notify the transplant physician and update the candidate's status to reflect current kidney function

Declining GFR during the waitlist period must be communicated to the transplant team to reassess status and potentially update MELD/waitlist priority.

Which pulmonary function test result would most likely prompt concern during pre-transplant evaluation for a non-pulmonary organ?

Answer: FEV1 of 38% predicted with diffusion capacity <40% predicted

Severely reduced FEV1 and diffusion capacity indicate significant lung disease that markedly increases perioperative pulmonary complication risk.