CCTC Evaluation and Preparation for Transplant 4 — Questions and Answers
Question 1: Which scoring system is used to assess disease severity and waitlist priority for patients with primary biliary cholangitis awaiting liver transplant?
- Child-Pugh alone
- MELD or MELD-Na (Correct answer)
- Mayo Risk Score only
- UKELD score
Correct answer: MELD or MELD-Na
MELD or MELD-Na is the standard UNOS allocation tool used for all chronic liver disease etiologies including primary biliary cholangitis.
Question 2: A renal transplant candidate has a BMI of 42. What is the primary concern at most transplant centers regarding listing this patient?
- BMI has no impact on transplant outcomes
- Increased risk of wound complications, delayed graft function, and reduced graft survival (Correct answer)
- The patient requires a living donor only
- Heart failure risk only
Correct answer: Increased risk of wound complications, delayed graft function, and reduced graft survival
Morbid obesity (BMI >40) is associated with higher surgical complication rates, wound dehiscence, delayed graft function, and worse long-term graft survival.
Question 3: During evaluation, a liver transplant candidate is found to have hepatopulmonary syndrome (HPS). How does this affect their transplant candidacy?
- HPS is an absolute contraindication
- Severe HPS may qualify the patient for MELD exception points and HPS typically reverses post-transplant (Correct answer)
- HPS requires combined liver-lung transplant in all cases
- HPS has no impact on listing or allocation
Correct answer: Severe HPS may qualify the patient for MELD exception points and HPS typically reverses post-transplant
HPS is a complication of portal hypertension that typically reverses after liver transplant; severe HPS (PaO2 <60 mmHg) can qualify patients for exception MELD points.
Question 4: What is the significance of elevated panel reactive antibody (PRA) levels greater than 80% in a kidney transplant candidate?
- The patient is considered unsensitized and easy to match
- The patient is highly sensitized, limiting compatible donors and increasing rejection risk (Correct answer)
- The patient must receive a living donor kidney only
- PRA >80% mandates splenectomy before transplant
Correct answer: The patient is highly sensitized, limiting compatible donors and increasing rejection risk
PRA >80% indicates high sensitization, meaning fewer compatible donors are available and the risk of antibody-mediated rejection is significantly elevated.
Question 5: A candidate being evaluated for heart transplant has significant, unresolved pulmonary hypertension with transpulmonary gradient >15 mmHg. What is the most likely outcome of this finding?
- Immediate listing with standard allocation priority
- Deferral pending optimization; severe fixed pulmonary hypertension contraindicates transplant due to right heart failure risk (Correct answer)
- Automatic upgrade to Status 1A
- Requirement for bilateral lung transplant only
Correct answer: Deferral pending optimization; severe fixed pulmonary hypertension contraindicates transplant due to right heart failure risk
Fixed pulmonary hypertension causes acute right ventricular failure in the donor heart; candidates must undergo vasodilator challenge to determine reversibility before listing.
Question 6: Which condition defines portopulmonary hypertension (POPH), and how does it affect liver transplant candidacy?
- POPH is hypoxemia due to intrapulmonary shunting; it is an absolute contraindication
- POPH is pulmonary arterial hypertension in the setting of portal hypertension; moderate cases may be bridged to transplant with vasodilator therapy (Correct answer)
- POPH is identical to hepatopulmonary syndrome and always reverses post-transplant
- POPH only occurs after transplant
Correct answer: POPH is pulmonary arterial hypertension in the setting of portal hypertension; moderate cases may be bridged to transplant with vasodilator therapy
POPH is pulmonary arterial hypertension complicating portal hypertension; moderate POPH responsive to vasodilator therapy can be bridged to transplant, while severe unresponsive POPH is a contraindication.
Question 7: Which specialist is most important to include in the multidisciplinary transplant evaluation team when a candidate has poorly controlled diabetes?
- Rheumatologist
- Endocrinologist (Correct answer)
- Dermatologist
- Ophthalmologist (alone)
Correct answer: Endocrinologist
An endocrinologist optimizes glycemic control pre- and post-transplant, as immunosuppressive medications like steroids significantly worsen diabetes after transplant.
CCTC Evaluation and Preparation for Transplant 4
Which scoring system is used to assess disease severity and waitlist priority for patients with primary biliary cholangitis awaiting liver transplant?