CCTC Organ-Specific Transplant Knowledge 4 — Questions and Answers
Question 1: A potential lung donor has a smoking history of 30 pack-years. Which additional evaluation is most critical before accepting the lungs?
- CT scan of the chest
- Bronchoscopy to assess airway and secretions (Correct answer)
- Pulmonary function testing with spirometry
- Arterial blood gas on room air
Correct answer: Bronchoscopy to assess airway and secretions
Bronchoscopy allows direct visualization of the airways, assessment of secretions, purulence, or aspiration that would disqualify the lungs from transplantation.
Question 2: What is the significance of donor-specific antibodies (DSA) detected de novo after kidney transplantation?
- They have no clinical significance
- They indicate successful tolerance induction
- They are a strong predictor of antibody-mediated rejection and graft loss (Correct answer)
- They only develop in ABO-incompatible transplants
Correct answer: They are a strong predictor of antibody-mediated rejection and graft loss
De novo DSA are antibodies the recipient develops against donor HLA antigens post-transplant and are strongly associated with antibody-mediated rejection and decreased long-term graft survival.
Question 3: In heart-lung transplantation, what is the most common indication in adult recipients?
- COPD
- Pulmonary arterial hypertension (PAH) with right heart failure (Correct answer)
- Cystic fibrosis
- Idiopathic pulmonary fibrosis
Correct answer: Pulmonary arterial hypertension (PAH) with right heart failure
Pulmonary arterial hypertension with irreversible right ventricular failure is the most frequent indication for combined heart-lung transplantation in adults.
Question 4: Which bile duct reconstruction technique is preferred in liver transplantation when recipient bile duct is of adequate quality?
- Roux-en-Y hepaticojejunostomy
- Duct-to-duct choledochocholedochostomy (Correct answer)
- Cholecystojejunostomy
- Hepaticogastrostomy
Correct answer: Duct-to-duct choledochocholedochostomy
Duct-to-duct (choledochocholedochostomy) biliary anastomosis is preferred as it preserves the sphincter of Oddi and allows ERCP access for post-transplant biliary complications.
Question 5: A deceased donor is found to have mild coronary artery disease on angiography. Under which circumstance might the heart still be considered for transplantation?
- Never; any CAD is an absolute contraindication
- If recipient is Status 1A with no other available donors (Correct answer)
- If donor is under age 30
- Only in pediatric recipients
Correct answer: If recipient is Status 1A with no other available donors
In urgent circumstances such as a Status 1A recipient with no alternatives, a heart with mild CAD may be accepted after careful risk-benefit analysis by the transplant team.
Question 6: Which condition in a liver transplant recipient most commonly requires conversion to Roux-en-Y biliary reconstruction?
- Primary biliary cholangitis recurrence
- Biliary stricture not amenable to endoscopic dilation (Correct answer)
- Hepatic artery thrombosis
- Portal vein thrombosis
Correct answer: Biliary stricture not amenable to endoscopic dilation
Biliary strictures that cannot be managed endoscopically require surgical revision to Roux-en-Y hepaticojejunostomy to restore bile drainage.
Question 7: What is the primary purpose of induction immunosuppression therapy in kidney transplantation?
- Treat established acute rejection episodes
- Provide intense early immunosuppression to prevent rejection at the time of highest risk (Correct answer)
- Replace maintenance tacrolimus permanently
- Reduce the need for HLA matching
Correct answer: Provide intense early immunosuppression to prevent rejection at the time of highest risk
Induction therapy with agents like basiliximab or rabbit anti-thymocyte globulin provides powerful immunosuppression during the peri-transplant period when rejection risk is highest.
CCTC Organ-Specific Transplant Knowledge 4
A potential lung donor has a smoking history of 30 pack-years.
Which additional evaluation is most critical before accepting the lungs?