CCTC Immediate Postoperative Care 3 — Questions and Answers
Question 1: Which laboratory value is the most sensitive early marker for hepatic artery thrombosis after liver transplant?
- Serum bilirubin
- Liver transaminases (AST/ALT) (Correct answer)
- Prothrombin time (PT)
- Serum albumin
Correct answer: Liver transaminases (AST/ALT)
Transaminases (AST/ALT) rise rapidly and dramatically with hepatic artery thrombosis due to acute hepatocellular ischemia.
Question 2: A renal transplant patient in the immediate postoperative period develops oliguria with a rising creatinine. Doppler ultrasound shows normal arterial and venous flow. What is the most likely cause?
- Hyperacute rejection
- Delayed graft function (DGF) (Correct answer)
- Ureteral obstruction
- Calcineurin inhibitor toxicity
Correct answer: Delayed graft function (DGF)
Delayed graft function is the most common cause of oliguria with normal blood flow after kidney transplant, typically resulting from ischemia-reperfusion injury.
Question 3: What is the primary purpose of maintaining a strict fluid balance record in the immediate post-transplant period?
- To calculate caloric intake
- To detect early signs of rejection
- To guide fluid resuscitation and detect third-spacing or hemorrhage (Correct answer)
- To determine readiness for extubation
Correct answer: To guide fluid resuscitation and detect third-spacing or hemorrhage
Precise fluid balance monitoring guides resuscitation and helps detect hemorrhage, third-spacing, or inadequate organ perfusion early.
Question 4: Which post-transplant complication is best detected by Doppler ultrasound in the immediate postoperative period?
- Acute cellular rejection
- Vascular thrombosis of graft vessels (Correct answer)
- Calcineurin inhibitor toxicity
- BK virus nephropathy
Correct answer: Vascular thrombosis of graft vessels
Doppler ultrasound is the first-line imaging study to evaluate vascular complications such as arterial or venous thrombosis in the transplanted organ.
Question 5: A post-liver transplant patient develops confusion and asterixis on postoperative day 2 despite a functioning graft. What metabolic complication should be suspected?
- Hyperglycemia
- Hyponatremia
- Hyperammonemia (Correct answer)
- Hypocalcemia
Correct answer: Hyperammonemia
Residual hyperammonemia from the pretransplant liver disease can persist postoperatively and cause encephalopathy even with a functioning graft.
Question 6: In the immediate post-heart transplant period, which hemodynamic parameter is most closely monitored to assess right ventricular function?
- Systemic vascular resistance (SVR)
- Central venous pressure (CVP) and pulmonary artery pressures (Correct answer)
- Left ventricular end-diastolic pressure
- Cardiac output via thermodilution only
Correct answer: Central venous pressure (CVP) and pulmonary artery pressures
CVP and pulmonary artery pressures reflect right heart filling and function, which is critical as the RV is most vulnerable post-heart transplant.
Question 7: Which wound complication is unique to kidney transplant recipients compared to other solid organ transplants?
- Surgical site infection
- Lymphocele formation (Correct answer)
- Hematoma at anastomosis site
- Dehiscence
Correct answer: Lymphocele formation
Lymphocele is a complication specific to kidney transplant due to disruption of lymphatic channels around the iliac vessels during implantation.
CCTC Immediate Postoperative Care 3
Which laboratory value is the most sensitive early marker for hepatic artery thrombosis after liver transplant?