Transplant Surgery Practice Questions

Q: After the first postoperative year of cardiac transplantation, what is the most common cause of death?

Accelerated graft arteriosclerosis. **Explanation:** The survival of cardiac transplant recipients is divided into two distinct phases: the early postoperative period (within the first year) and the late postoperative period (after one year). **Why 'Accelerated Graft Arteriosclerosis' is correct:** Also known as **Cardiac Allograft Vasculopathy (CAV)**, this is a unique, progressive form of chronic rejection. Unlike typical atherosclerosis, CAV is characterized by diffuse, concentric intimal proliferation affecting the entire length of the coronary arteries. It remains the leading cause of late mortality (after 1 year) because the denervated heart does not experience typical angina, often leading to silent myocardial infarction, heart failure, or sudden death. **Why the other options are incorrect:** * **Infection:** This is the **most common cause of death within the first year** (specifically the first 30 days to 6 months) due to intense induction immunosuppression. * **Acute Rejection:** This typically occurs within the first 3–6 months. While it remains a risk, its incidence decreases significantly after the first year due to maintenance therapy. * **Arrhythmia:** While arrhythmias can occur due to surgical trauma or acute rejection in the early phase, they are rarely the primary cause of late-term mortality unless secondary to CAV. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common cause of death ( 1 year):** Cardiac Allograft Vasculopathy (CAV) / Graft Arteriosclerosis. 3. **Gold Standard for CAV diagnosis:** Annual coronary angiography with **Intravascular Ultrasound (IVUS)**, as angiography alone may underestimate the diffuse narrowing. 4. **Malignancy:** The risk of lymphomas (PTLD) and skin cancers increases significantly in the late phase due to long-term immunosuppression.

Q: What type of graft is a graft from a sister to a brother?

Allograft. ### Explanation The correct answer is **Allograft (Option B)**. **1. Why Allograft is correct:** An **allograft** (or homograft) is a transplant between two genetically non-identical members of the same species. Since a brother and sister share approximately 50% of their genetic material (unless they are monozygotic twins), they are genetically distinct individuals. Therefore, any organ or tissue transfer between them is classified as an allograft. This requires immunosuppression to prevent T-cell mediated rejection. **2. Why other options are incorrect:** * **Isograft (Option A):** This is a graft between genetically identical individuals. In humans, this only occurs between **monozygotic (identical) twins**. Since the question specifies a brother and sister (who are dizygotic/siblings), they cannot be genetically identical. * **Autograft (Option C):** This involves a graft taken from one part of a patient's body and transferred to another part of the **same individual** (e.g., a skin graft from the thigh to the arm or a CABG using the radial artery). There is no risk of rejection. * **Heterograft (Option D):** Also known as a **Xenograft**, this is a transplant between members of **different species** (e.g., a porcine/pig heart valve transplanted into a human). **3. Clinical Pearls for NEET-PG:** * **Hyperacute Rejection:** Occurs within minutes to hours due to pre-formed antibodies (Type II Hypersensitivity). * **Acute Rejection:** Occurs within days to weeks; primarily T-cell mediated (Type IV Hypersensitivity). * **Chronic Rejection:** Occurs months to years later; characterized by fibrosis and vascular occlusion. * **Order of Immunogenicity:** Xenograft > Allograft > Isograft = Autograft. * **Graft-versus-Host Disease (GVHD):** Most common in bone marrow transplants where donor T-cells attack the recipient's tissues.

Q: A parathyroid gland is implanted into the forearm muscle. What type of transplantation is this?

Heterotopic. ### Explanation The correct answer is **Heterotopic** transplantation. **1. Why Heterotopic is Correct:** In transplant surgery, the classification is based on the anatomical site of implantation. **Heterotopic transplantation** occurs when a tissue or organ is implanted into an anatomical location different from its original physiological position. * **Clinical Context:** In patients undergoing total parathyroidectomy (e.g., for secondary hyperparathyroidism), a portion of the parathyroid gland is often autotransplanted into the **brachioradialis muscle** of the forearm. This allows the gland to maintain endocrine function while being easily accessible for monitoring or partial resection if recurrence occurs. **2. Why Other Options are Incorrect:** * **Orthotopic (Option A):** This refers to placing the graft in its **normal anatomical position** after removing the diseased organ. A classic example is a Liver Transplant, where the donor liver replaces the recipient's liver in the right upper quadrant. * **Auxiliary (Option C):** This is a subtype of heterotopic transplant where the graft is placed in a different location **without removing the recipient's native organ**. The graft "assists" the failing organ. An example is an auxiliary liver transplant placed in the infra-mesocolic space. **3. High-Yield Clinical Pearls for NEET-PG:** * **Autograft:** Transfer of tissue within the same individual (e.g., the parathyroid forearm transplant mentioned above). * **Allograft:** Transfer between genetically different members of the same species (most cadaveric organ transplants). * **Isograft (Syngeneic):** Transfer between genetically identical individuals (monozygotic twins). * **Xenograft:** Transfer between different species (e.g., porcine heart valve). * **Renal Transplant:** Most kidney transplants are **Heterotopic** (placed in the iliac fossa), not orthotopic.

Question 1

After the first postoperative year of cardiac transplantation, what is the most common cause of death?

Accepted Answer

Accelerated graft arteriosclerosis

Answer

Infection

Answer

Arrhythmia

Answer

Acute rejection episode

Question 2

Infection in a renal transplant patient is usually caused by which pathogen?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Human Immunodeficiency Virus (HIV)

Answer

Herpes Simplex Virus (HSV)

Answer

Salmonella

Question 3

What type of graft is a graft from a sister to a brother?

Accepted Answer

Allograft

Answer

Isograft

Answer

Autograft

Answer

Heterograft

Question 4

Compared to early immunosuppressive drugs such as azathioprine, steroids, and anti-lymphocyte serum, what specific advantages do newer immunosuppressive agents offer?

Accepted Answer

Tacrolimus (FK506) shares properties with cyclosporine but is particularly useful for rescuing grafts failing under cyclosporine therapy.

Answer

Cyclosporine interferes with lymphokine production and has neither bone marrow nor renal toxicity.

Answer

Monoclonal antibody (OKT3) is more available, more specific, and has fewer side effects than anti-lymphocyte serum.

Answer

None of the above.

Question 5

A parathyroid gland is implanted into the forearm muscle. What type of transplantation is this?

Accepted Answer

Heterotopic

Answer

Orthotopic

Answer

Auxiliary

Answer

None of the above

Transplant Surgery — MCQs

Transplant Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?