CCTC Organ-Specific Transplant Knowledge 2 — Questions and Answers
Question 1: Which hemodynamic parameter is most critical to optimize in a potential heart donor to ensure graft viability?
- Central venous pressure 8-12 mmHg
- Mean arterial pressure ≥60 mmHg (Correct answer)
- Pulmonary capillary wedge pressure >18 mmHg
- Heart rate >100 bpm
Correct answer: Mean arterial pressure ≥60 mmHg
Maintaining mean arterial pressure ≥60 mmHg ensures adequate coronary perfusion and preserves heart graft function.
Question 2: What is the maximum recommended cold ischemia time for a transplanted kidney to minimize delayed graft function?
- 12 hours
- 18 hours
- 24 hours (Correct answer)
- 36 hours
Correct answer: 24 hours
Kidney cold ischemia time should ideally be kept under 24 hours to reduce the risk of delayed graft function.
Question 3: In liver transplantation, which condition in the recipient is associated with the highest urgency on the UNOS waiting list?
- Hepatitis C cirrhosis with MELD 25
- Acute liver failure with life expectancy <7 days (Status 1A) (Correct answer)
- Alcoholic hepatitis with MELD 30
- Hepatocellular carcinoma within Milan criteria
Correct answer: Acute liver failure with life expectancy <7 days (Status 1A)
Status 1A designates patients with acute liver failure and predicted survival less than 7 days without transplant, conferring highest priority.
Question 4: Which lung function parameter is the primary determinant when evaluating a potential lung donor for suitability?
- FEV1/FVC ratio
- PaO2/FiO2 ratio (P/F ratio) ≥300 (Correct answer)
- Residual volume
- Diffusing capacity (DLCO)
Correct answer: PaO2/FiO2 ratio (P/F ratio) ≥300
A P/F ratio ≥300 on 100% FiO2 and 5 cmH2O PEEP indicates adequate gas exchange and donor lung viability.
Question 5: Following pancreas transplantation, which laboratory value is the most direct indicator of graft exocrine function failure?
- Serum amylase
- Serum lipase
- Urine amylase (in bladder-drained grafts) (Correct answer)
- Blood glucose
Correct answer: Urine amylase (in bladder-drained grafts)
In bladder-drained pancreas transplants, a fall in urine amylase is the earliest and most sensitive marker of exocrine graft rejection.
Question 6: A heart transplant candidate has a panel reactive antibody (PRA) of 85%. What is the primary clinical implication?
- Reduced risk of acute rejection
- High likelihood of hyperacute rejection without prospective crossmatch (Correct answer)
- Requirement for ABO-incompatible transplant protocol
- Automatic removal from the waiting list
Correct answer: High likelihood of hyperacute rejection without prospective crossmatch
A high PRA indicates broad sensitization to HLA antigens, significantly increasing the risk of hyperacute rejection if a prospective crossmatch is not performed.
Question 7: Which preservation solution is most commonly used for kidney and liver procurement during multi-organ procurement?
- Normal saline
- University of Wisconsin (UW) solution (Correct answer)
- Lactated Ringer's solution
- Euro-Collins solution
Correct answer: University of Wisconsin (UW) solution
University of Wisconsin (UW) solution is the gold standard cold storage preservation solution for kidneys, livers, and pancreata due to its oncotic and metabolic protective properties.
CCTC Organ-Specific Transplant Knowledge 2
Which hemodynamic parameter is most critical to optimize in a potential heart donor to ensure graft viability?