CCTC Organ-Specific Transplant Knowledge 5 — Questions and Answers
Question 1: A kidney from a donor after cardiac death (DCD) is expected to have a higher rate of which complication compared to a standard criteria donor kidney?
- Hyperacute rejection
- Delayed graft function (DGF) (Correct answer)
- Primary non-function of the liver
- Acute antibody-mediated rejection
Correct answer: Delayed graft function (DGF)
DCD kidneys experience warm ischemia during the withdrawal-to-perfusion interval, causing tubular injury that manifests as delayed graft function at higher rates than brain-dead donor kidneys.
Question 2: In liver transplantation, what does a MELD score of 40 indicate?
- Low medical urgency, patient can wait years
- Approximately 71% 90-day mortality without transplantation (Correct answer)
- Eligibility for living donor liver transplant only
- Presence of hepatocellular carcinoma
Correct answer: Approximately 71% 90-day mortality without transplantation
A MELD score of 40 correlates with approximately 71% mortality at 90 days without a transplant, indicating critical urgency for organ allocation.
Question 3: Which post-transplant infection is most commonly associated with the first month after solid organ transplantation?
- CMV pneumonitis
- Pneumocystis jirovecii pneumonia (PCP)
- Surgical site infections and nosocomial bacterial infections (Correct answer)
- Cryptococcal meningitis
Correct answer: Surgical site infections and nosocomial bacterial infections
In the first month post-transplant, nosocomial bacterial infections and surgical site infections predominate due to surgery, catheters, and hospitalization.
Question 4: What is the primary advantage of using a living donor for kidney transplantation compared to a deceased donor?
- Eliminates need for immunosuppression
- Superior long-term graft survival and minimal cold ischemia time (Correct answer)
- No need for HLA matching
- Avoids risk of delayed graft function entirely
Correct answer: Superior long-term graft survival and minimal cold ischemia time
Living donor kidneys have superior long-term outcomes due to planned procurement, minimal cold ischemia time, and the ability to optimize recipient preparation.
Question 5: Which parameter is used to calculate the Kidney Donor Risk Index (KDRI) to assess deceased donor kidney quality?
- Donor serum creatinine only
- Multiple donor factors including age, height, weight, cause of death, and creatinine (Correct answer)
- Recipient MELD score
- Cold ischemia time alone
Correct answer: Multiple donor factors including age, height, weight, cause of death, and creatinine
The KDRI is a composite score incorporating multiple donor characteristics to estimate the risk of graft failure relative to a reference donor.
Question 6: A lung transplant recipient at 2 years post-transplant develops progressive obstructive physiology on PFTs with bronchiolitis obliterans on biopsy. What syndrome does this represent?
- Restrictive allograft syndrome
- Chronic lung allograft dysfunction (CLAD) — bronchiolitis obliterans syndrome (BOS) (Correct answer)
- Acute cellular rejection grade A3
- Primary graft dysfunction
Correct answer: Chronic lung allograft dysfunction (CLAD) — bronchiolitis obliterans syndrome (BOS)
BOS is the most common form of CLAD, characterized by progressive airflow obstruction from fibrotic obliteration of small airways and is the leading cause of late mortality after lung transplant.
Question 7: Following liver transplantation, which vascular complication is most effectively diagnosed by Doppler ultrasound in the early post-operative period?
- Biliary anastomotic stricture
- Portal vein thrombosis (Correct answer)
- Hepatic vein outflow obstruction
- Inferior vena cava stenosis
Correct answer: Portal vein thrombosis
Portal vein thrombosis is readily detected by Doppler ultrasound assessing portal venous flow, and early diagnosis allows intervention to salvage the graft.
CCTC Organ-Specific Transplant Knowledge 5
A kidney from a donor after cardiac death (DCD) is expected to have a higher rate of which complication compared to a standard criteria donor kidney?