CCTC Evaluation and Preparation for Transplant 2 — Questions and Answers
Question 1: Which pulmonary function test value below the threshold typically contraindicates lung transplant evaluation?
- FEV1 < 20% predicted
- DLCO < 20% predicted (Correct answer)
- FVC < 50% predicted
- RV/TLC > 70%
Correct answer: DLCO < 20% predicted
A DLCO below 20% predicted is associated with extremely high post-operative mortality and is generally considered a contraindication to lung transplant.
Question 2: During pretransplant cardiac evaluation for a kidney transplant candidate, which finding would most likely EXCLUDE the patient from listing?
- Mild mitral regurgitation
- Ejection fraction of 35% unresponsive to optimization (Correct answer)
- Controlled atrial fibrillation
- First-degree AV block
Correct answer: Ejection fraction of 35% unresponsive to optimization
Severe left ventricular dysfunction with an EF of 35% that does not improve with medical optimization is a relative-to-absolute contraindication for kidney transplant due to perioperative cardiac risk.
Question 3: A liver transplant candidate has a MELD-Na score of 28. What does this primarily indicate?
- The patient is too healthy for transplant
- Higher 90-day mortality risk and greater urgency for transplant (Correct answer)
- The patient should be removed from the waitlist
- The patient requires simultaneous kidney transplant
Correct answer: Higher 90-day mortality risk and greater urgency for transplant
MELD-Na scores reflect 90-day waitlist mortality; higher scores indicate sicker patients who are prioritized for organ allocation.
Question 4: Which immunological test is performed to detect preformed antibodies against HLA antigens in a transplant candidate?
- ABO blood typing
- Panel Reactive Antibody (PRA) testing (Correct answer)
- Mixed lymphocyte culture
- Complement fixation test
Correct answer: Panel Reactive Antibody (PRA) testing
PRA testing identifies the breadth of a candidate's sensitization by detecting preformed anti-HLA antibodies that could cause hyperacute rejection.
Question 5: What is the primary purpose of a virtual crossmatch in transplant evaluation?
- To simulate surgical outcomes using computer modeling
- To compare donor HLA typing against recipient antibody profiles without mixing actual cells (Correct answer)
- To predict graft survival at 5 years
- To allocate organs based on geographic distance
Correct answer: To compare donor HLA typing against recipient antibody profiles without mixing actual cells
Virtual crossmatch uses donor HLA typing and recipient DSA data to predict crossmatch results without requiring physical serum and cells, enabling faster organ placement.
Question 6: A kidney transplant candidate is found to have significant peripheral vascular disease on evaluation. What is the most important implication for surgical planning?
- The patient needs a simultaneous pancreas transplant
- Vascular surgeons must assess iliac vessel patency before listing (Correct answer)
- The patient should undergo carotid endarterectomy first
- Laparoscopic donor surgery is preferred
Correct answer: Vascular surgeons must assess iliac vessel patency before listing
Peripheral vascular disease affecting iliac vessels can jeopardize anastomosis success; vascular assessment is mandatory to determine surgical feasibility.
Question 7: Which nutritional parameter is most commonly assessed and optimized before listing a patient for liver transplant?
- Serum cholesterol
- Sarcopenia assessment via CT or muscle function testing (Correct answer)
- Vitamin D levels alone
- Body mass index only
Correct answer: Sarcopenia assessment via CT or muscle function testing
Sarcopenia, detected via CT cross-sectional muscle area or functional testing, is strongly associated with post-transplant mortality and is a primary nutritional target pre-listing.
CCTC Evaluation and Preparation for Transplant 2
Which pulmonary function test value below the threshold typically contraindicates lung transplant evaluation?