CCTC Pre-Transplant Candidate Evaluation 4 — Questions and Answers
Question 1: A candidate for kidney-pancreas transplant has Type 1 diabetes with a hemoglobin A1c of 11.2%. What does this finding suggest about transplant candidacy?
- The patient is an ideal candidate due to severe diabetes
- Poor glycemic control may indicate need for optimization and assessment of end-organ complications (Correct answer)
- A1c level has no relevance to transplant eligibility
- The patient should receive pancreas transplant alone first
Correct answer: Poor glycemic control may indicate need for optimization and assessment of end-organ complications
Markedly elevated A1c suggests poor glycemic control and prompts further evaluation of diabetes-related complications that affect surgical risk and outcomes.
Question 2: During pre-transplant evaluation, serologic testing reveals the candidate is HCV antibody positive. After direct-acting antiviral treatment, HCV RNA is undetectable. How does this affect listing?
- The patient is permanently excluded due to prior HCV infection
- Sustained virologic response (SVR) after antiviral treatment generally does not preclude transplant listing (Correct answer)
- The patient must wait 5 years after SVR before listing
- HCV-treated patients can only receive HCV-positive donor organs
Correct answer: Sustained virologic response (SVR) after antiviral treatment generally does not preclude transplant listing
Achieving SVR with current direct-acting antivirals effectively cures HCV, and cured patients are generally eligible for transplant listing under standard criteria.
Question 3: A transplant candidate being evaluated for kidney transplant has a documented history of multiple episodes of medical non-compliance resulting in hospitalizations. How should the transplant team approach this?
- Immediately list the patient since past behavior does not predict future outcomes
- Conduct thorough psychosocial assessment, identify barriers to adherence, and develop a plan before listing (Correct answer)
- Permanently deny listing for all non-compliant patients
- List the patient but assign lower priority on the waitlist
Correct answer: Conduct thorough psychosocial assessment, identify barriers to adherence, and develop a plan before listing
Non-adherence is a modifiable risk factor; a thorough psychosocial workup to understand barriers and develop support plans is the standard approach before a listing decision.
Question 4: What is the purpose of the 6-minute walk test (6MWT) in pre-transplant evaluation for heart or lung transplant candidates?
- To diagnose coronary artery disease
- To objectively assess functional capacity and predict perioperative risk and post-transplant outcomes (Correct answer)
- To determine MELD score components
- To evaluate kidney function before transplant
Correct answer: To objectively assess functional capacity and predict perioperative risk and post-transplant outcomes
The 6MWT provides an objective measure of functional exercise capacity that correlates with disease severity, waitlist mortality, and post-transplant rehabilitation potential.
Question 5: A 65-year-old kidney transplant candidate has no history of colon cancer but has never had a colonoscopy. What is the standard recommendation before listing?
- No colonoscopy is needed for patients without symptoms
- Age-appropriate cancer screening including colonoscopy should be completed prior to transplant listing (Correct answer)
- Colonoscopy is only required if the patient has a first-degree relative with colon cancer
- Colonoscopy should be deferred until 1 year post-transplant
Correct answer: Age-appropriate cancer screening including colonoscopy should be completed prior to transplant listing
Pre-transplant evaluation requires completion of all age-appropriate cancer screenings, including colonoscopy, because immunosuppression after transplant can accelerate undetected malignancies.
Question 6: Which finding would most likely lead to a thorough neurological evaluation before kidney transplant listing in an elderly candidate?
- Well-controlled hypertension
- Cognitive impairment identified on the Montreal Cognitive Assessment (MoCA) (Correct answer)
- History of a single uncomplicated febrile seizure 20 years ago
- Mild peripheral neuropathy from diabetes
Correct answer: Cognitive impairment identified on the Montreal Cognitive Assessment (MoCA)
Cognitive impairment raises concerns about the candidate's ability to manage complex post-transplant medication regimens and informed consent capacity.
Question 7: A patient with autosomal dominant polycystic kidney disease (ADPKD) is being evaluated for kidney transplant and has massively enlarged kidneys causing abdominal discomfort and recurrent infections. What surgical consideration arises?
- The native kidneys must always be removed before transplant listing
- Native nephrectomy may be required to create adequate space for the transplanted kidney (Correct answer)
- ADPKD patients are never candidates for kidney transplant
- The transplant kidney is placed in the native renal fossa requiring mandatory bilateral nephrectomy
Correct answer: Native nephrectomy may be required to create adequate space for the transplanted kidney
Massively enlarged polycystic kidneys can occupy retroperitoneal space needed for the transplanted organ, making pretransplant or simultaneous native nephrectomy necessary.
CCTC Pre-Transplant Candidate Evaluation 4
A candidate for kidney-pancreas transplant has Type 1 diabetes with a hemoglobin A1c of 11.2%.
What does this finding suggest about transplant candidacy?