Pre-Transplant Candidate Evaluation Flashcards

A potential liver transplant candidate with alcoholic cirrhosis has been abstinent from alcohol for 4 months. Most transplant centers require a minimum of how long of documented sobriety?

Answer: 6 months

The traditional '6-month rule' of sobriety is used by most programs, though evidence for this threshold is debated and individualized assessment is increasingly advocated.

During pre-transplant evaluation, a kidney candidate's echocardiogram reveals an ejection fraction of 30% with dilated cardiomyopathy. What is the most appropriate next step?

Answer: Refer to cardiology for optimization of heart failure therapy and reassess cardiac function before finalizing listing

Reduced ejection fraction requires cardiology evaluation and optimization of heart failure treatment; listing may proceed if cardiac function improves sufficiently.

A pre-transplant candidate has an incidental finding of a 2 cm renal mass on imaging during kidney transplant evaluation. What should occur before listing?

Answer: Obtain further characterization with CT or MRI and urology consultation to exclude malignancy

Any suspicious renal mass requires urologic evaluation and potential biopsy or resection to rule out malignancy before immunosuppression is initiated.

What is the primary goal of recipient HLA typing performed during pre-transplant evaluation?

Answer: To identify the recipient's HLA antigens for crossmatch testing and identifying unacceptable antigens

HLA typing defines the recipient's antigen profile, enabling crossmatch testing against potential donors and identification of donor-specific antibodies to avoid.

A transplant coordinator is reviewing a candidate's medication history and notes prolonged use of high-dose NSAIDs. Why is this particularly relevant for kidney transplant evaluation?

Answer: NSAIDs are directly nephrotoxic and may have accelerated kidney disease progression

Chronic NSAID use is nephrotoxic and may have contributed to or accelerated progression of kidney disease, which is important for understanding disease etiology.

When obtaining informed consent for transplant listing, which element is most critical for the transplant coordinator to ensure the candidate understands?

Answer: The risks, benefits, alternatives, and lifelong commitment to immunosuppression and medical follow-up required after transplant

True informed consent requires that the candidate fully understands the permanent nature of post-transplant immunosuppression, associated risks, and required lifelong follow-up.

A transplant candidate is found to have a serum ferritin of 3,200 ng/mL and transferrin saturation of 62% during pre-transplant labs. What workup should be initiated?

Answer: Evaluation for hereditary hemochromatosis including HFE gene mutation testing and liver biopsy if indicated

Markedly elevated ferritin with high transferrin saturation suggests iron overload and warrants evaluation for hereditary hemochromatosis, which requires treatment before transplant.