CCTC Pre-Transplant Candidate Evaluation 5 — Questions and Answers
Question 1: A potential liver transplant candidate with alcoholic cirrhosis has been abstinent from alcohol for 4 months. Most transplant centers require a minimum of how long of documented sobriety?
- 1 month
- 6 months (Correct answer)
- 2 years
- 18 months
Correct answer: 6 months
The traditional '6-month rule' of sobriety is used by most programs, though evidence for this threshold is debated and individualized assessment is increasingly advocated.
Question 2: During pre-transplant evaluation, a kidney candidate's echocardiogram reveals an ejection fraction of 30% with dilated cardiomyopathy. What is the most appropriate next step?
- List the patient immediately as this is common in dialysis patients
- Refer to cardiology for optimization of heart failure therapy and reassess cardiac function before finalizing listing (Correct answer)
- Automatically deny listing due to low ejection fraction
- Proceed with transplant listing but note the finding in the chart
Correct answer: Refer to cardiology for optimization of heart failure therapy and reassess cardiac function before finalizing listing
Reduced ejection fraction requires cardiology evaluation and optimization of heart failure treatment; listing may proceed if cardiac function improves sufficiently.
Question 3: A pre-transplant candidate has an incidental finding of a 2 cm renal mass on imaging during kidney transplant evaluation. What should occur before listing?
- Ignore the finding as the patient already has end-stage renal disease
- Obtain further characterization with CT or MRI and urology consultation to exclude malignancy (Correct answer)
- Remove the patient from evaluation and recommend palliative care
- List immediately and plan to monitor the mass post-transplant
Correct answer: Obtain further characterization with CT or MRI and urology consultation to exclude malignancy
Any suspicious renal mass requires urologic evaluation and potential biopsy or resection to rule out malignancy before immunosuppression is initiated.
Question 4: What is the primary goal of recipient HLA typing performed during pre-transplant evaluation?
- To calculate the patient's MELD score
- To identify the recipient's HLA antigens for crossmatch testing and identifying unacceptable antigens (Correct answer)
- To determine ABO blood type compatibility
- To screen for genetic diseases that may recur after transplant
Correct answer: To identify the recipient's HLA antigens for crossmatch testing and identifying unacceptable antigens
HLA typing defines the recipient's antigen profile, enabling crossmatch testing against potential donors and identification of donor-specific antibodies to avoid.
Question 5: A transplant coordinator is reviewing a candidate's medication history and notes prolonged use of high-dose NSAIDs. Why is this particularly relevant for kidney transplant evaluation?
- NSAIDs are directly nephrotoxic and may have accelerated kidney disease progression (Correct answer)
- NSAIDs interact with transplant immunosuppressants making them contraindicated post-transplant
- NSAID use indicates the patient will be non-compliant post-transplant
- Long-term NSAID use is a contraindication to kidney transplant listing
Correct answer: NSAIDs are directly nephrotoxic and may have accelerated kidney disease progression
Chronic NSAID use is nephrotoxic and may have contributed to or accelerated progression of kidney disease, which is important for understanding disease etiology.
Question 6: When obtaining informed consent for transplant listing, which element is most critical for the transplant coordinator to ensure the candidate understands?
- The names of all surgical team members
- The risks, benefits, alternatives, and lifelong commitment to immunosuppression and medical follow-up required after transplant (Correct answer)
- The estimated cost of each immunosuppressive medication
- The exact waitlist position they will receive upon listing
Correct answer: The risks, benefits, alternatives, and lifelong commitment to immunosuppression and medical follow-up required after transplant
True informed consent requires that the candidate fully understands the permanent nature of post-transplant immunosuppression, associated risks, and required lifelong follow-up.
Question 7: A transplant candidate is found to have a serum ferritin of 3,200 ng/mL and transferrin saturation of 62% during pre-transplant labs. What workup should be initiated?
- No further evaluation is needed as elevated ferritin is common in dialysis patients
- Evaluation for hereditary hemochromatosis including HFE gene mutation testing and liver biopsy if indicated (Correct answer)
- Immediate referral for bone marrow biopsy to evaluate for malignancy
- Start iron chelation therapy and list the patient simultaneously
Correct answer: Evaluation for hereditary hemochromatosis including HFE gene mutation testing and liver biopsy if indicated
Markedly elevated ferritin with high transferrin saturation suggests iron overload and warrants evaluation for hereditary hemochromatosis, which requires treatment before transplant.
CCTC Pre-Transplant Candidate Evaluation 5
A potential liver transplant candidate with alcoholic cirrhosis has been abstinent from alcohol for 4 months.
Most transplant centers require a minimum of how long of documented sobriety?