CCTC Pre-Transplant Candidate Evaluation 3 — Questions and Answers
Question 1: A candidate for liver transplant has a MELD score of 28. What does this score primarily reflect?
- The patient's quality of life and functional status
- The 90-day mortality risk from liver disease and urgency for transplantation (Correct answer)
- The patient's compatibility with potential donors
- The expected post-transplant survival probability
Correct answer: The 90-day mortality risk from liver disease and urgency for transplantation
The MELD score (Model for End-Stage Liver Disease) estimates 90-day mortality from liver failure and is used to prioritize waitlist candidates by urgency.
Question 2: Which cancer history is generally considered an absolute contraindication to solid organ transplantation?
- Basal cell carcinoma treated 10 years ago with clear margins
- Active metastatic malignancy with no curative treatment available (Correct answer)
- Stage I breast cancer treated 5 years ago with no recurrence
- Cervical carcinoma in situ treated successfully 3 years prior
Correct answer: Active metastatic malignancy with no curative treatment available
Active metastatic malignancy without curative options is an absolute contraindication because immunosuppression would accelerate tumor progression.
Question 3: During nutritional assessment of a cirrhotic liver transplant candidate, severe sarcopenia is identified. Why is this clinically significant?
- Sarcopenia has no effect on transplant outcomes
- Sarcopenia is associated with increased waitlist mortality and worse post-transplant outcomes (Correct answer)
- Sarcopenia only affects kidney transplant candidates
- Sarcopenic patients automatically receive MELD exception points
Correct answer: Sarcopenia is associated with increased waitlist mortality and worse post-transplant outcomes
Severe muscle wasting (sarcopenia) in cirrhotic patients is independently associated with higher waitlist mortality and increased post-transplant morbidity.
Question 4: A patient being evaluated for heart transplant has been treated for non-Hodgkin's lymphoma and has been in remission for 3 years. What is the standard approach to this history?
- Automatic disqualification with no further evaluation
- Apply disease-free interval criteria (typically 2-5 years) and assess recurrence risk with oncology (Correct answer)
- List immediately since 3 years is always sufficient
- Require 10 years of remission before any transplant evaluation
Correct answer: Apply disease-free interval criteria (typically 2-5 years) and assess recurrence risk with oncology
Most centers apply disease-specific disease-free interval requirements and require oncology clearance; for lymphoma, 3 years may be acceptable depending on histology and risk.
Question 5: A potential kidney transplant candidate has significant bilateral iliac artery calcification on CT imaging. Why is this relevant to transplant evaluation?
- It affects only the patient's cardiac risk stratification
- Severe vascular disease may prevent adequate arterial anastomosis for the transplanted kidney (Correct answer)
- It is a contraindication to transplant in all cases
- It only matters for pancreas transplant candidates
Correct answer: Severe vascular disease may prevent adequate arterial anastomosis for the transplanted kidney
Severe iliac artery calcification can compromise blood flow to the transplanted kidney and complicate surgical vascular anastomosis.
Question 6: A transplant coordinator notes that a candidate's calculated GFR has been declining during the waitlist period. What action is most appropriate?
- No action is needed until the patient requires dialysis
- Notify the transplant physician and update the candidate's status to reflect current kidney function (Correct answer)
- Remove the patient from the waitlist until GFR stabilizes
- Immediately activate the patient as Status 1A
Correct answer: Notify the transplant physician and update the candidate's status to reflect current kidney function
Declining GFR during the waitlist period must be communicated to the transplant team to reassess status and potentially update MELD/waitlist priority.
Question 7: Which pulmonary function test result would most likely prompt concern during pre-transplant evaluation for a non-pulmonary organ?
- FEV1/FVC ratio of 0.78
- FEV1 of 38% predicted with diffusion capacity <40% predicted (Correct answer)
- Mild restrictive pattern with TLC of 78% predicted
- SpO2 of 95% at rest on room air
Correct answer: FEV1 of 38% predicted with diffusion capacity <40% predicted
Severely reduced FEV1 and diffusion capacity indicate significant lung disease that markedly increases perioperative pulmonary complication risk.
CCTC Pre-Transplant Candidate Evaluation 3
A candidate for liver transplant has a MELD score of 28.
What does this score primarily reflect?