CCTC Pre-Transplant Candidate Evaluation 2 — Questions and Answers
Question 1: A 58-year-old patient with end-stage renal disease has a panel reactive antibody (PRA) of 85%. What does this indicate for transplant planning?
- The patient is highly sensitized and will have difficulty finding a compatible donor (Correct answer)
- The patient has a very low risk of rejection
- The patient is an ideal candidate for living donor transplant only
- The patient should be removed from the waiting list
Correct answer: The patient is highly sensitized and will have difficulty finding a compatible donor
A PRA of 85% means the patient has antibodies against 85% of the donor pool, making compatible organ matching significantly more difficult.
Question 2: Which cardiac evaluation is typically required before listing a patient with diabetes mellitus for kidney transplantation?
- Echocardiogram only
- Stress testing or coronary angiography to assess for occult coronary artery disease (Correct answer)
- Chest X-ray and EKG only
- Holter monitor for 24 hours
Correct answer: Stress testing or coronary angiography to assess for occult coronary artery disease
Diabetic patients are at high risk for silent coronary artery disease, so functional stress testing or angiography is standard pre-listing cardiac evaluation.
Question 3: A transplant candidate is found to have a positive PPD skin test with no prior BCG vaccination and no active symptoms. What is the appropriate management?
- Immediate removal from the transplant waitlist
- Prophylactic isoniazid (INH) therapy before and after transplant (Correct answer)
- No treatment needed unless active disease develops post-transplant
- Rifampin therapy for 6 months prior to listing
Correct answer: Prophylactic isoniazid (INH) therapy before and after transplant
Latent TB identified by positive PPD without prior BCG warrants prophylactic INH to prevent reactivation after immunosuppression.
Question 4: During pre-transplant psychosocial evaluation, a candidate discloses ongoing alcohol use despite prior treatment. What is the transplant team's most appropriate next step?
- List the patient immediately since alcohol use is not a contraindication
- Require a mandatory sobriety period and engagement with addiction treatment before listing (Correct answer)
- Refer to psychiatry and list the patient concurrently
- Deny listing permanently due to substance use history
Correct answer: Require a mandatory sobriety period and engagement with addiction treatment before listing
Most transplant programs require documented sobriety (typically 6 months) and active addiction treatment engagement before listing alcohol-dependent candidates.
Question 5: Which finding on abdominal imaging would most concern the transplant team when evaluating a liver transplant candidate?
- Small gallstones without cholecystitis
- Portal vein thrombosis extending into the superior mesenteric vein (Correct answer)
- Mild splenomegaly
- Small volume ascites responsive to diuretics
Correct answer: Portal vein thrombosis extending into the superior mesenteric vein
Extensive portal vein thrombosis involving the superior mesenteric vein significantly complicates liver transplant surgery and may be a contraindication.
Question 6: A pre-transplant candidate has a BMI of 42 kg/m². How does this typically affect transplant listing decisions?
- BMI has no impact on transplant outcomes or listing criteria
- Morbid obesity is associated with increased perioperative risk and many centers require weight loss before listing (Correct answer)
- The patient should receive an immediate living donor transplant to avoid waitlist time
- Only patients with BMI over 50 face any restrictions
Correct answer: Morbid obesity is associated with increased perioperative risk and many centers require weight loss before listing
Morbid obesity (BMI ≥40) significantly increases surgical risk and many transplant centers require weight reduction to a safer BMI threshold before listing.
Question 7: When performing a pre-transplant crossmatch, a T-cell flow cytometry crossmatch returns positive. What is the clinical implication?
- No clinical significance; transplant can proceed without modification
- The recipient has donor-specific antibodies against T-cell antigens, increasing hyperacute rejection risk (Correct answer)
- This result indicates ABO incompatibility
- The result means the donor organ is not viable
Correct answer: The recipient has donor-specific antibodies against T-cell antigens, increasing hyperacute rejection risk
A positive T-cell flow crossmatch indicates donor-specific antibodies against HLA antigens on T cells, which is generally a contraindication to transplant due to rejection risk.
CCTC Pre-Transplant Candidate Evaluation 2
A 58-year-old patient with end-stage renal disease has a panel reactive antibody (PRA) of 85%.
What does this indicate for transplant planning?