Transplant Surgery Practice Questions

Q: Highest chance of success in renal transplant is seen when the donor is:

Identical twin. **Explanation:** The success of a renal transplant is primarily determined by the degree of **HLA (Human Leukocyte Antigen) matching** between the donor and the recipient. **1. Why Identical Twin is Correct:** Identical (monozygotic) twins are genetically identical, meaning they share a **100% HLA match** (6/6 antigens). Because the recipient’s immune system recognizes the donor tissue as "self," there is virtually no risk of host-versus-graft rejection. This eliminates the need for long-term maintenance immunosuppression, leading to the highest graft survival rates and the best long-term outcomes. **2. Why Other Options are Incorrect:** * **Father/Mother (Options B & C):** These are "Haploidentical" donors. A child inherits one HLA haplotype from each parent, resulting in only a **50% (3/6) match**. While successful, they carry a higher risk of rejection compared to an identical twin. * **Sister (Option D):** Siblings have a 25% chance of being a perfect HLA match, a 50% chance of being a half-match, and a 25% chance of being a total mismatch. While a "HLA-identical sibling" is the second-best choice after an identical twin, the option simply states "Sister," which does not guarantee a 100% match. **High-Yield Clinical Pearls for NEET-PG:** * **Order of Donor Preference:** Identical Twin > HLA-identical Sibling > Parent/Haploidentical Sibling > Deceased (Cadaveric) Donor. * **First Successful Transplant:** Performed by Joseph Murray in 1954 between identical twins (the Herrick brothers). * **Hyperacute Rejection:** Occurs within minutes/hours due to pre-formed antibodies (Type II Hypersensitivity). * **Most Common Site:** The donor kidney is usually placed in the **Right Iliac Fossa** (extraperitoneal) for easier vascular access and ureteral implantation.

Q: Which of the following organs obtained from a cadaver is not used for transplant?

Urinary bladder. **Explanation:** The correct answer is **D. Urinary bladder**. In transplant surgery, organs and tissues are harvested from cadaveric donors (typically brain-dead or heart-beating donors) based on their functional necessity and the feasibility of the procedure. **Why Urinary Bladder is not used:** The urinary bladder is currently **not** a standard organ for transplantation. This is primarily because the bladder is a complex muscular reservoir that requires intricate neural coordination for storage and voiding. Transplanting a bladder would involve difficult reinnervation that current medical technology cannot reliably achieve. Furthermore, for patients with end-stage bladder disease or malignancy, effective alternatives exist, such as **urinary diversion** (e.g., Ileal conduit) or **neobladder reconstruction** using the patient's own bowel segments (enterocystoplasty). **Analysis of Incorrect Options:** * **A. Blood vessels:** Vascular allografts (arteries and veins) are frequently harvested from cadavers and used in bypass surgeries or complex reconstructions when autologous grafts are unavailable. * **B. Lung:** Lung transplantation is a standard procedure for end-stage pulmonary diseases like COPD, cystic fibrosis, and ILD. * **C. Liver:** The liver is one of the most commonly transplanted cadaveric organs, used for end-stage liver disease and acute liver failure. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organ transplanted:** Kidney (followed by Liver). * **Most common tissue transplanted:** Cornea. * **Warm Ischemia Time:** The time an organ remains at body temperature after its blood supply is cut off. The heart and lungs are most sensitive (approx. 4–6 hours). * **Preservation Solution:** University of Wisconsin (UW) solution is the gold standard for multi-organ preservation.

Q: A 55-year-old woman with cirrhosis requires liver transplantation. Her MELD score is 28, and she has been on the waiting list for 8 months. She presents with confusion, asterixis, and ammonia level of 150 μg/dL (normal 15-45). What is the most important consideration for transplant candidacy at this time?

Hepatic encephalopathy suggests end-stage disease. ***Hepatic encephalopathy suggests end-stage disease*** - The presence of **hepatic encephalopathy** (confusion, asterixis, elevated ammonia) indicates severe, **end-stage liver disease**, making liver transplantation highly urgent and potentially the only definitive treatment. - While MELD score dictates initial priority, the acute presentation of encephalopathy in a patient with a high MELD score highlights the critical need for a transplant. *Presence of ascites* - While ascites is a common complication of cirrhosis, it is a **less urgent indicator** for transplant candidacy than acute hepatic encephalopathy. - Ascites can often be managed medically, unlike acute severe encephalopathy, which necessitates an immediate transplant. *Length of time on waiting list* - The length of time on the waiting list is a factor in **transplant allocation**, but it does not supersede the urgency of acute, severe complications like hepatic encephalopathy. - A patient's medical status and **likelihood of survival** are primary considerations, overriding waiting time alone. *Reversibility of hepatic encephalopathy with treatment* - Although treatment for hepatic encephalopathy (e.g., lactulose, rifaximin) can temporarily improve symptoms, it does not address the underlying **progressive liver failure**. - The goal of transplantation is to treat the **irreversible liver disease**, not just its transient complications.

Q: In which location is a transplanted kidney typically placed?

Iliac fossa. ***Iliac fossa*** - The **iliac fossa** is the standard site for kidney transplantation due to its accessibility and the proximity of suitable blood vessels (iliac artery and vein) for anastomosis. [1] - Placing the kidney here allows for easier access for potential biopsies and monitoring. *Retroperitoneal space* - The patient's native kidneys are located in the **retroperitoneal space**, but a transplanted kidney is typically placed in a more accessible anterior location. - Transplanting a kidney into the retroperitoneal space would be a more complex and invasive procedure due to the depth and surrounding structures. *Hypogastric region* - While the iliac fossa is part of the broader hypogastric region, the term **hypogastric region** is less specific for the precise anatomical location of kidney transplantation. - The iliac fossa specifically refers to the concave surface of the ilium, which provides a suitable bed for the donated kidney. *Kidney fossa* - **Kidney fossa** is not a formally recognized anatomical term for a specific site of kidney transplantation. - The term "fossa" describes a depression or hollow, but in the context of transplantation, the iliac fossa is the correct anatomical landmark used.

Q: Xenograft is transplantation of tissue:

From a different species. ***From a different species*** - A **xenograft** (or heterograft) is the transplantation of cells, tissues, or organs from **one species to another**, such as from a pig to a human. - This type of transplant faces significant immunological challenges due to the **genetic disparity** between the donor and recipient. *From same species* - This describes an **allograft** (or homograft), where tissue is transplanted between genetically distinct individuals of the **same species**. - Examples include organ transplants between unrelated humans. *From genetically identical twins* - This describes an **isograft** (or syngeneic graft), which involves transplantation between **genetically identical individuals**, such as monozygotic twins. - These grafts typically have the **highest success rate** due to minimal immune rejection. *From one part of body to another* - This describes an **autograft**, where tissue is transplanted from one site to another **within the same individual**. - Examples include a skin graft from the thigh to a burned area on the arm or a **coronary artery bypass graft** using a leg vein; these grafts are not rejected as they originate from the patient's own body.

Q: What is the documented mortality rate for healthy liver donors undergoing donor hepatectomy?

Mortality for donor is 0.2 to 0.4 %. ***Correct: Mortality for donor is 0.2 to 0.4%*** - Studies indicate that the **mortality rate** for healthy liver donors undergoing **donor hepatectomy** is very low, typically ranging from **0.2% to 0.4%**. - This rate reflects the extensive **pre-operative screening** and careful surgical techniques used to ensure donor safety. - Current data from major transplant centers worldwide support this range as the most accurate representation of donor risk. *Incorrect: Mortality for donor is 0.6 to 0.8%* - This range is **higher** than the generally accepted and documented mortality rates for healthy liver donors. - While complications can occur, fatal outcomes are rare, making this percentage an **overestimation** of actual risk. *Incorrect: Mortality for donor is 0.5%* - This mortality rate is also **higher** than the current reported rates for living liver donation in well-established centers. - Continuous advancements in surgical safety and donor selection have driven the mortality rate **below 0.5%** in most high-volume centers. *Incorrect: Mortality for donor is 1%* - A 1% mortality rate for healthy liver donors would be considered **unacceptably high** given the current standards of care. - This percentage severely **overestimates** the actual risks associated with living related liver donation and does not reflect modern surgical outcomes.

Q: All are Indications of liver transplant except

Cholangiocarcinoma. ***Cholangiocarcinoma*** - **Cholangiocarcinoma** is a **contraindication** for liver transplantation due to its aggressive nature and high recurrence rate post-transplant, except in highly selected early cases treated with neoadjuvant therapy. - The risk of **tumor recurrence** and poor long-term survival generally outweighs the benefits of transplantation for this malignancy. *Biliary atresia* - **Biliary atresia** is the most common indication for **pediatric liver transplantation**. - It involves the progressive destruction of bile ducts, leading to **cholestasis**, cirrhosis, and liver failure in infants. *Cirrhosis* - **Cirrhosis** from various etiologies (e.g., viral hepatitis, alcohol, NASH) is a primary indication for liver transplantation when it leads to **decompensated liver disease** or end-stage liver failure. - Patients with complications like **ascites**, **encephalopathy**, or recurrent variceal bleeding often require transplant. *Fulminant hepatitis* - **Fulminant hepatitis** (acute liver failure) rapidly progresses to severe liver dysfunction and encephalopathy in individuals without pre-existing liver disease. - It is an urgent indication for **emergent liver transplantation** to prevent multi-organ failure and death.

Q: Most common complication after intestinal transplantation is

Sepsis. ***Sepsis*** - **Infection** is the leading cause of morbidity and mortality after intestinal transplantation, making **sepsis** the most common complication. - The immunocompromised state due to immunosuppressive therapy and the inherent bacterial load of the gastrointestinal tract contribute significantly to the high risk of severe infections. *Intestinal obstruction* - While intestinal obstruction can occur post-transplant due to adhesions or strictures, it is **less common** than infectious complications. - It typically manifests later and may require surgical intervention but doesn't have the same high frequency as sepsis. *Graft versus host disease* - **Graft-versus-host disease (GVHD)** is a significant complication in intestinal transplantation, but it is **not the most common**. - Its incidence varies, and while serious, it does not surpass the overall frequency of infectious complications and sepsis. *Intestinal necrosis* - **Intestinal necrosis** (e.g., due to infarction or severe rejection) is a severe complication but is **less frequent** than sepsis. - It is often a consequence of vascular compromise or overwhelming rejection, leading to graft failure or perforation.

Q: All of the following are true about the history of transplantation except:

First successful intestinal transplantation by Hardy. ***First successful intestinal transplantation by Hardy*** - The **first successful intestinal transplantation** was **NOT performed by Hardy**. - **Hardy** is famous for the **first human lung transplant** in **1963** and the **first heart xenotransplant** (chimpanzee to human) in **1964**. - **Intestinal transplantation** had its first long-term success in the late **1980s** (notably by **Starzl** and others after the introduction of cyclosporine). - This statement is **FALSE**, making it the correct answer to this "EXCEPT" question. *First pancreas transplantation by Kelly & Lillhei* - The **first successful human pancreas transplant** was indeed performed by **William Kelly** and **Richard Lillehei** at the University of Minnesota in **1966**. - This was a **simultaneous pancreas-kidney transplant** for a patient with diabetes and renal failure. - This statement is **TRUE**. *First lung transplantation by Fritz Derom* - This is **contextually TRUE** when referring to the **first successful lung transplant with meaningful survival**. - **James Hardy** performed the **first human lung transplant** in **1963**, but the patient survived only **18 days**. - **Fritz Derom** (Belgium) performed a lung transplant in **1968** with the patient surviving **10 months**, representing the first case with significant survival. - In transplant history, Derom is often credited as this represented a more meaningful milestone. - This statement is generally considered **TRUE**. *First heart & lung transplantation by Reitz & Shumway* - **Bruce Reitz** and his team at Stanford University, working under **Norman Shumway**, performed the **first successful combined heart-lung transplant** in **1981**. - The patient, Mary Gohlke, survived for **5 years** post-transplant. - This statement is **TRUE**.

Question 1

Highest chance of success in renal transplant is seen when the donor is:

Accepted Answer

Identical twin

Answer

Father

Answer

Mother

Answer

Sister

Question 2

Which of the following organs obtained from a cadaver is not used for transplant?

Accepted Answer

Urinary bladder

Answer

Blood vessels

Answer

Lung

Answer

Liver

Question 3

Which of the following is a criterion for a pancreas donor?

Accepted Answer

No history of diabetes

Answer

No history of liver donation

Answer

No replaced hepatic artery vessels arising from the superior mesenteric artery (SMA)

Answer

No previous splenectomy

Question 4

A 55-year-old woman with cirrhosis requires liver transplantation. Her MELD score is 28, and she has been on the waiting list for 8 months. She presents with confusion, asterixis, and ammonia level of 150 μg/dL (normal 15-45). What is the most important consideration for transplant candidacy at this time?

Accepted Answer

Hepatic encephalopathy suggests end-stage disease

Answer

Presence of ascites

Answer

Length of time on waiting list

Answer

Reversibility of hepatic encephalopathy with treatment

Question 5

In which location is a transplanted kidney typically placed?

Accepted Answer

Iliac fossa

Answer

Retroperitoneal space

Answer

Hypogastric region

Answer

Kidney fossa

Question 6

Xenograft is transplantation of tissue:

Accepted Answer

From a different species

Answer

From same species

Answer

From genetically identical twins

Answer

From one part of body to another

Question 7

What is the documented mortality rate for healthy liver donors undergoing donor hepatectomy?

Accepted Answer

Mortality for donor is 0.2 to 0.4 %

Answer

Mortality for donor is 0.6 to 0.8 %

Answer

Mortality for donor is 0.5 %

Answer

Mortality for donor is 1%

Question 8

All are Indications of liver transplant except

Accepted Answer

Cholangiocarcinoma

Answer

Biliary atresia

Answer

Cirrhosis

Answer

Fulminant hepatitis

Question 9

Most common complication after intestinal transplantation is

Accepted Answer

Sepsis

Answer

Intestinal obstruction

Answer

Graft vs host disease

Answer

Intestinal necrosis

Question 10

All of the following are true about the history of transplantation except:

Accepted Answer

First successful intestinal transplantation by Hardy

Answer

First pancreas transplantation by Kelly & Lillhei

Answer

First lung transplantation by Fritz Derom

Answer

First heart & lung transplantation by Reitz & Shumway

Transplant Surgery — MCQs

Transplant Surgery — MCQs

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