CTP Donor & Recipient Evaluation 4 — Questions and Answers
Question 1: Which scoring system is used to assess the quality and predicted graft function of a deceased donor kidney before transplantation?
- KDRI (Kidney Donor Risk Index) (Correct answer)
- SOFA score
- APACHE II score
- DRI (Donor Risk Index for liver)
Correct answer: KDRI (Kidney Donor Risk Index)
The KDRI estimates the relative risk of kidney graft failure based on donor characteristics such as age, creatinine, hypertension, and cause of death.
Question 2: In donation after circulatory death (DCD), which organ is considered MOST vulnerable to warm ischemia during the withdrawal of life support phase?
- Kidney
- Liver (Correct answer)
- Lung
- Cornea
Correct answer: Liver
The liver is most sensitive to warm ischemia in DCD donors and has the highest risk of primary non-function and ischemic cholangiopathy.
Question 3: Which donor condition is classified as a 'Public Health Service (PHS) Increased Risk' behavior that must be disclosed to potential recipients?
- History of type 2 diabetes mellitus
- Incarceration in the past 12 months (Correct answer)
- Age greater than 65 years
- Prior appendectomy
Correct answer: Incarceration in the past 12 months
PHS Increased Risk criteria include recent incarceration (within 12 months) because of higher prevalence of blood-borne infections in this population.
Question 4: A recipient has a calculated PRA of 85%. What does this indicate about their transplant candidacy?
- They are unsuitable for transplantation
- They are highly sensitized and will likely need a virtual or prospective crossmatch (Correct answer)
- They have low risk of rejection due to strong immune response
- They must receive a living donor kidney only
Correct answer: They are highly sensitized and will likely need a virtual or prospective crossmatch
A PRA of 85% indicates high sensitization, meaning the recipient has antibodies against 85% of the population, requiring careful crossmatch strategy.
Question 5: Which factor is part of the standard evaluation for assessing a living kidney donor's long-term renal reserve?
- 24-hour urine creatinine clearance or GFR measurement (Correct answer)
- Serum phosphorus level
- Urine osmolality after water deprivation
- Fractional excretion of sodium (FENa)
Correct answer: 24-hour urine creatinine clearance or GFR measurement
Measured GFR or 24-hour urine creatinine clearance is essential to confirm adequate bilateral renal function before nephrectomy in living donors.
Question 6: Which condition in a potential lung donor would be an absolute contraindication to lung procurement?
- PaO2/FiO2 ratio of 380 mmHg
- Active aspiration pneumonia with purulent secretions on bronchoscopy (Correct answer)
- Tobacco history of 15 pack-years
- Single prior episode of pneumonia 2 years ago
Correct answer: Active aspiration pneumonia with purulent secretions on bronchoscopy
Active aspiration pneumonia with purulent secretions indicates severe parenchymal infection that would lead to primary graft dysfunction in the recipient.
Question 7: In recipient evaluation for heart transplantation, which hemodynamic measurement, if severely elevated and fixed, may contraindicate transplantation?
- Cardiac output
- Pulmonary vascular resistance (PVR) (Correct answer)
- Left ventricular ejection fraction
- Systemic vascular resistance
Correct answer: Pulmonary vascular resistance (PVR)
Fixed, severely elevated PVR (>5 Wood units) that does not respond to vasodilator challenge increases the risk of acute right heart failure in the donor heart after transplant.
CTP Donor & Recipient Evaluation 4
Which scoring system is used to assess the quality and predicted graft function of a deceased donor kidney before transplantation?