CCTC Immediate Postoperative Care 2 — Questions and Answers
Question 1: A kidney transplant recipient in the ICU has urine output of 800 mL/hr in the first postoperative hour. What is the most appropriate initial management?
- Administer furosemide to reduce output
- Replace urine output mL-for-mL with IV fluids (Correct answer)
- Restrict fluids to prevent fluid overload
- Notify the surgeon immediately for re-exploration
Correct answer: Replace urine output mL-for-mL with IV fluids
Brisk diuresis after kidney transplant requires mL-for-mL fluid replacement to maintain adequate perfusion and prevent dehydration.
Question 2: Which electrolyte abnormality is most commonly associated with a large diuresis in the immediate post-kidney transplant period?
- Hyperkalemia
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia is common after large diuresis as potassium is lost in high urine volumes, requiring monitoring and replacement.
Question 3: A liver transplant patient develops a sudden decrease in bile output from the T-tube on postoperative day 1. What should the transplant coordinator suspect first?
- Normal physiologic response
- Biliary anastomotic leak
- Hepatic artery thrombosis (Correct answer)
- Acute cellular rejection
Correct answer: Hepatic artery thrombosis
Hepatic artery thrombosis causes sudden cessation of bile production and is the most feared early complication after liver transplant.
Question 4: What is the target mean arterial pressure (MAP) goal typically maintained in the immediate post-transplant ICU period?
- Above 50 mmHg
- Above 65 mmHg (Correct answer)
- Above 90 mmHg
- Above 110 mmHg
Correct answer: Above 65 mmHg
A MAP above 65 mmHg is the standard target to ensure adequate perfusion pressure to the transplanted organ.
Question 5: A heart transplant recipient is noted to have a heart rate of 48 bpm on postoperative day 1. Which medication is used to increase heart rate in the denervated transplanted heart?
- Atropine
- Isoproterenol (Correct answer)
- Digoxin
- Metoprolol
Correct answer: Isoproterenol
The denervated transplanted heart does not respond to atropine; isoproterenol acts directly on beta-1 receptors and is the drug of choice.
Question 6: In the immediate postoperative period, which immunosuppressive agent is most commonly associated with nephrotoxicity?
- Mycophenolate mofetil
- Prednisone
- Calcineurin inhibitors (tacrolimus/cyclosporine) (Correct answer)
- Azathioprine
Correct answer: Calcineurin inhibitors (tacrolimus/cyclosporine)
Calcineurin inhibitors cause afferent arteriolar vasoconstriction leading to nephrotoxicity, which must be monitored closely post-transplant.
Question 7: A lung transplant patient develops increasing hypoxia with bilateral infiltrates on CXR within 72 hours of transplant. What is the most likely diagnosis?
- Acute cellular rejection
- Primary graft dysfunction (PGD) (Correct answer)
- Pulmonary embolism
- Ventilator-associated pneumonia
Correct answer: Primary graft dysfunction (PGD)
Primary graft dysfunction presents within 72 hours with hypoxia and bilateral infiltrates from ischemia-reperfusion injury to the donor lung.
CCTC Immediate Postoperative Care 2
A kidney transplant recipient in the ICU has urine output of 800 mL/hr in the first postoperative hour.
What is the most appropriate initial management?