CCTC Evaluation and Preparation for Transplant 3 — Questions and Answers
Question 1: A heart transplant candidate with a history of treated lymphoma is being evaluated. What minimum cancer-free interval is generally required before listing?
- 6 months
- 1 year
- 2 years (Correct answer)
- 5 years
Correct answer: 2 years
Most transplant centers require at least 2 to 5 years of cancer-free interval depending on tumor type and stage, balancing recurrence risk against transplant urgency.
Question 2: Which hepatic lesion scoring system is used to prioritize liver transplant candidates with hepatocellular carcinoma (HCC) within UNOS criteria?
- CLIP score
- Milan Criteria with MELD exception points (Correct answer)
- Barcelona Clinic Liver Cancer staging alone
- Child-Pugh class
Correct answer: Milan Criteria with MELD exception points
Candidates with HCC within Milan Criteria (1 lesion ≤5 cm or up to 3 lesions ≤3 cm each, no vascular invasion) receive MELD exception points to improve their allocation priority.
Question 3: When evaluating a patient for kidney-pancreas transplant, which condition in the recipient must be present to justify simultaneous pancreas transplantation?
- Type 2 diabetes with insulin resistance
- Type 1 diabetes with end-stage renal disease (Correct answer)
- Gestational diabetes history
- Pre-diabetes with hypoglycemia unawareness
Correct answer: Type 1 diabetes with end-stage renal disease
Simultaneous pancreas-kidney (SPK) transplant is primarily indicated in Type 1 diabetics with ESRD, as both organs address insulin deficiency and its renal complications.
Question 4: During psychosocial evaluation, which factor is considered an ABSOLUTE contraindication to transplant listing at most centers?
- History of depression treated with medication
- Active alcohol or substance abuse without documented sobriety (Correct answer)
- Anxiety disorder requiring benzodiazepines
- Mild cognitive impairment with caregiver support
Correct answer: Active alcohol or substance abuse without documented sobriety
Active substance abuse without documented sobriety and treatment is an absolute contraindication because it predicts non-adherence and graft failure.
Question 5: A transplant coordinator reviews crossmatch results and notes a positive T-cell crossmatch. What does this finding indicate?
- Compatible donor-recipient pair; proceed with transplant
- Presence of donor-specific antibodies against HLA class I antigens; transplant is contraindicated (Correct answer)
- Minor blood group incompatibility requiring desensitization only
- NK cell mediated rejection risk only
Correct answer: Presence of donor-specific antibodies against HLA class I antigens; transplant is contraindicated
A positive T-cell crossmatch indicates DSA against class I HLA on donor T-cells, predicting hyperacute or accelerated rejection and is a contraindication to transplant.
Question 6: What is the role of a financial coordinator in the pretransplant evaluation process?
- Determining organ allocation priority scores
- Verifying insurance coverage and identifying funding gaps for transplant and post-transplant care (Correct answer)
- Prescribing immunosuppression protocols
- Performing psychosocial screening
Correct answer: Verifying insurance coverage and identifying funding gaps for transplant and post-transplant care
Financial coordinators ensure the patient has adequate coverage for surgery, hospitalization, and lifelong immunosuppression, as financial non-adherence can lead to graft loss.
Question 7: Which pre-transplant vaccination is especially critical to administer BEFORE transplant in all candidates, given its live-attenuated nature?
- Influenza (inactivated)
- Pneumococcal (PPSV23)
- Varicella zoster (Zostavax) (Correct answer)
- Hepatitis B (recombinant)
Correct answer: Varicella zoster (Zostavax)
Live-attenuated vaccines like varicella/zoster must be given before transplant because post-transplant immunosuppression precludes safe administration of live vaccines.
CCTC Evaluation and Preparation for Transplant 3
A heart transplant candidate with a history of treated lymphoma is being evaluated.
What minimum cancer-free interval is generally required before listing?