Transplant Surgery Practice Questions

Q: Transplantation of liver is contraindicated in:

Metastasis to liver. ***Metastasis to liver*** - The presence of **metastasis to the liver** from another primary cancer is a general contraindication for liver transplantation. - This is because the underlying malignancy is systemic, and transplantation would not cure the cancer, with high risk of **disease recurrence** in the transplanted organ or elsewhere. *Renal failure* - **Renal failure** alone is not an absolute contraindication for liver transplantation; patients with **hepatorenal syndrome** or chronic kidney disease can undergo combined liver-kidney transplantation. - The decision depends on the reversibility of renal failure and the overall clinical picture. *Acute fulminant liver disease* - **Acute fulminant liver disease** is a common and often urgent **indication** for liver transplantation, not a contraindication. - Transplantation is life-saving in these cases when medical management fails due to rapid deterioration and high mortality. *Viral hepatitis* - **Viral hepatitis** (e.g., hepatitis C, hepatitis B) is a common cause of end-stage liver disease and is a leading **indication** for liver transplantation. - With modern antiviral therapies, patients can often receive a transplant and manage the viral recurrence post-transplant.

Q: Auxiliary orthotopic liver transplant is indicated for

Acute fulminant liver failure for any cause. ***Acute fulminant liver failure for any cause*** - **Auxiliary orthotopic liver transplant (AOLT)** is primarily indicated in acute fulminant liver failure because it allows for the potential regeneration of the native liver while providing immediate liver support. - This technique preserves the **native liver**, which can recover and take over function if the underlying cause is reversible, allowing for eventual withdrawal of immunosuppression. *Metabolic liver disease* - For **metabolic liver diseases**, the primary goal is often to replace the diseased liver with a healthy one to correct the metabolic defect, making **orthotopic liver transplantation (OLT)** the standard. - In most metabolic liver diseases, the native liver is permanently dysfunctional and not expected to recover significant function, rendering AOLT less beneficial. *Drug induced hepatic failure* - While drug-induced hepatic failure can be a form of acute liver failure, the scope of the option "Acute fulminant liver failure for any cause" is broader and more accurately encapsulates the primary indication for AOLT. - If the native liver has sustained irreversible damage from drugs, a full **orthotopic liver transplant** would be more appropriate than an auxiliary approach. *As a standby procedure until finding a suitable donor* - AOLT is a definitive treatment strategy aimed at liver support and potential native liver recovery, not a temporary measure to bridge to another transplant or donor. - The concept of a "standby procedure" until a donor is found typically refers to urgent **orthotopic liver transplantation** listings or temporary support like extracorporeal devices, not AOLT.

Q: Which of the following is true regarding extended criteria donors for liver transplantation?

Donors aged >60 years with no significant comorbidities. ***Donors aged >60 years with no significant comorbidities*** - **Advanced donor age** is a key characteristic of an extended criteria donor (ECD), especially when coupled with other factors like **ischemic time** or comorbidities. - While age alone might not prohibit donation, it puts the donor liver into the ECD category, requiring careful recipient selection and possibly increasing the risk of **post-transplant complications**. *Donors with well-controlled diabetes mellitus* - **Well-controlled diabetes mellitus** in a donor does not automatically classify them as an extended criteria donor, if there are no other significant associated comorbidities or organ damage. - The focus is generally on signs of significant end-organ damage or poorly controlled disease that could impact graft function. *Hepatitis C antibody positive donors* - **Hepatitis C antibody positive donors** are traditionally considered extended criteria donors and remain classified as such. - However, with the advent of highly effective **direct-acting antiviral (DAA) therapies**, HCV-positive organs can now be safely transplanted into both HCV-positive and HCV-negative recipients with excellent outcomes. - While still technically ECD, the clinical significance has diminished significantly with modern treatment availability, making **donor age >60 years** the more universally recognized ECD criterion in current practice. *Donors with significant uncontrolled comorbidities* - **Significant uncontrolled comorbidities** would generally render a donor **unsuitable for donation**, rather than classify them as an extended criteria donor. - Extended criteria typically refer to factors that increase risk but are still acceptable under specific circumstances, whereas uncontrolled comorbidities often pose too high a risk for successful transplantation.

Q: Renal transplantation is most commonly done in?

Chronic glomerulonephritis. ***Chronic glomerulonephritis*** - **Chronic glomerulonephritis** is one of the **major causes of end-stage renal disease (ESRD)** requiring renal transplantation, accounting for approximately **10-15% of transplants**. - It leads to progressive destruction of the glomeruli, resulting in irreversible loss of kidney function. - **Note:** In current practice, diabetic nephropathy and hypertensive nephrosclerosis are more common causes of ESRD, but among the options listed, chronic glomerulonephritis is the most significant indication for transplantation. *Horseshoe kidney* - A **horseshoe kidney** is a **congenital anatomical anomaly** where the kidneys are fused, usually at their lower poles. - While it can increase the risk of certain renal conditions like stones, infections, or hydronephrosis, it is **not a primary cause of ESRD** requiring transplantation. - Horseshoe kidney itself is not an indication for transplantation. *Bilateral staghorn calculus* - **Bilateral staghorn calculi** are large, branching kidney stones that can fill the renal pelvis and calyces. - While they can cause significant kidney damage, infection, and obstruction, they are **managed surgically** (percutaneous nephrolithotomy, ureteroscopy) and **rarely progress to ESRD** requiring transplantation if treated appropriately. - They represent a treatable condition rather than a primary transplant indication. *Oxalosis* - **Primary hyperoxaluria (oxalosis)** is a **rare genetic disorder** characterized by excessive oxalate production and deposition in kidneys and other organs. - Although it can lead to ESRD and requires combined **liver-kidney transplantation**, it is a **much less common** indication compared to chronic glomerulonephritis. - Accounts for <1% of transplant cases.

Q: Renal transplantation is preferred in

Chronic glomerulonephritis. ***Chronic glomerulonephritis*** - **Chronic glomerulonephritis** is a common cause of end-stage renal disease (ESRD), requiring renal replacement therapy like transplantation. [1] - Transplantation offers the best long-term outcomes and quality of life compared to dialysis for suitable ESRD patients. [1] *AKI* - **Acute kidney injury (AKI)** is often reversible and does not typically require renal transplantation. [1] - Management focuses on treating the underlying cause to restore kidney function. [1] *Bilateral staghorn calculus* - **Bilateral staghorn calculi** are usually managed with surgical intervention to remove the stones and preserve renal function. - Renal transplantation is not indicated unless the stones lead to irreversible **end-stage renal disease**. [1] *Bilateral hydronephrosis* - **Bilateral hydronephrosis** is treated by relieving the obstruction causing urine backup. - Kidney transplantation is considered only if the obstruction leads to **irreversible kidney damage** and **ESRD**. [1]

Q: What is safe maximum time for storage of heart?

6 hours. ***6 hours*** - The **ischemic time** for a donor heart before transplantation is ideally kept under **4-6 hours** to minimize damage and ensure successful engraftment. - **6 hours represents the absolute maximum** safe cold ischemic time, though shorter durations (closer to 4 hours) are associated with better outcomes. - Prolonged cold ischemic time significantly increases the risk of **primary graft dysfunction** and reduces long-term survival. *2 hours* - While a shorter ischemic time is always preferable, 2 hours is often not logistically feasible given the complexities of **organ retrieval** and **transportation**. - Many heart transplants are successfully performed with an ischemic time longer than 2 hours without major complications. - This would be an ideal but impractical limit in most real-world scenarios. *4 hours* - Although **4 hours** is the recommended optimal limit and many guidelines suggest this as the target, the question asks for the **maximum** safe time. - Most centers aim for under 4 hours, but can extend to 6 hours with acceptable outcomes for carefully selected donors and recipients. - The precise limit depends on various factors including the **donor's age and health**, and the preservation solution used. *8 hours* - An ischemic time of **8 hours** for a donor heart is generally considered too long and would result in a very high risk of **irreversible myocardial damage** and poor graft function. - This duration would lead to significantly increased rates of **primary graft failure** and mortality. - Beyond 6 hours, the risk of complications increases exponentially.

Q: Which animal's heart has been used for transplantation in humans?

Pig. ***Pig*** - **Pig hearts** and heart valves have been successfully used in **xenotransplantation** due to their physiological similarities to human hearts. - Recent advances in **genetic modification** have reduced the risk of rejection, making pig organs viable for human transplantation. *Rabbit* - Rabbit hearts are significantly smaller and anatomically distinct from human hearts, making them unsuitable for whole heart transplantation. - While rabbits are used in research, their organs lack the necessary size and physiological compatibility for human organ replacement. *Sheep* - Sheep hearts have been used in some research for cardiovascular device testing, but not for whole organ transplantation in humans. - Their heart size and physiology are not as closely matched to humans as pigs for xenotransplantation purposes. *Horse* - Horse hearts are considerably larger and structurally different from human hearts, posing significant anatomical and physiological challenges for transplantation. - There is no clinical or research precedent for horse heart transplantation into humans.

Q: All are indications of liver transplantation except:

Hepatic adenomas. ***Hepatic adenomas*** - **Hepatic adenomas** are benign liver tumors that generally do not require liver transplantation unless they are **very large**, symptomatic, or show signs of **malignant transformation** or rupture, which are rare indications compared to other severe liver diseases. - Management usually involves **surgical resection** or close monitoring, not transplantation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic cholestatic liver disease that often progresses to **cirrhosis** and liver failure, making it a common indication for liver transplantation. - It also carries an increased risk of **cholangiocarcinoma**, an indication for transplant if diagnosed early under specific criteria. *Fulminant hepatitis* - **Fulminant hepatitis** (acute liver failure) involves severe, rapid onset liver dysfunction with **encephalopathy** and coagulopathy in individuals without pre-existing liver disease. - It is a **life-threatening condition** that often necessitates urgent liver transplantation. *Alcoholic cirrhosis* - **Alcoholic cirrhosis** is a leading cause of end-stage liver disease and is a common indication for liver transplantation, often after a period of **abstinence** from alcohol. - Transplantation is considered when the liver damage is irreversible and life-threatening, and the patient meets specific criteria, including a commitment to sobriety.

Q: A graft that has been derived from another species of a different genetic disposition is also known as a:

Heterograft. ***Heterograft*** - A **heterograft**, also known as a **xenograft**, is a tissue graft transplanted between individuals of **different species**. - These grafts often face significant **immune rejection** due to the genetic disparity between the donor and recipient species. *Allograft* - An allograft is a transplant between two genetically **non-identical individuals of the same species**. - While they are from the same species, **immune responses** are still common due to genetic differences. *Isograft* - An isograft is a transplant between **genetically identical individuals**, such as **monozygotic (identical) twins**. - These grafts typically have the **lowest risk of immune rejection** because the host immune system recognizes them as "self." *Homograft* - The term **homograft** is often used interchangeably with **allograft**, referring to a graft from a **different individual of the same species**. - It is not specifically used to describe grafts between **different species**.

Question 1

Transplantation of liver is contraindicated in:

Accepted Answer

Metastasis to liver

Answer

Renal failure

Answer

Acute fulminant liver disease

Answer

Viral hepatitis

Question 2

Auxiliary orthotopic liver transplant is indicated for

Accepted Answer

Acute fulminant liver failure for any cause

Answer

Metabolic liver disease

Answer

Drug induced hepatic failure

Answer

As a standby procedure until finding a suitable donor

Question 3

Which of the following is true regarding extended criteria donors for liver transplantation?

Accepted Answer

Donors aged >60 years with no significant comorbidities

Answer

Donors with well-controlled diabetes mellitus

Answer

Hepatitis C antibody positive donors

Answer

Donors with significant uncontrolled comorbidities

Question 4

Renal transplantation is most commonly done in?

Accepted Answer

Chronic glomerulonephritis

Answer

Horseshoe kidney

Answer

Bilateral staghorn calculus

Answer

Oxalosis

Question 5

Renal transplantation is preferred in

Accepted Answer

Chronic glomerulonephritis

Answer

AKI

Answer

Bilateral staghorn calculus

Answer

Bilateral hydronephrosis

Question 6

What is safe maximum time for storage of heart?

Accepted Answer

6 hours

Answer

2 hours

Answer

4 hours

Answer

8 hours

Question 7

Which animal's heart has been used for transplantation in humans?

Accepted Answer

Pig

Answer

Rabbit

Answer

Sheep

Answer

Horse

Question 8

All are indications of liver transplantation except:

Accepted Answer

Hepatic adenomas

Answer

Primary sclerosing cholangitis

Answer

Fulminant hepatitis

Answer

Alcoholic cirrhosis

Answer

Primary biliary cirrhosis

Question 9

Which of the following diseases is appropriately treated with combined heart-lung transplantation?

Accepted Answer

Idiopathic dilated cardiomyopathy with long-standing secondary pulmonary hypertension

Answer

End-stage emphysema

Answer

Primary pulmonary hypertension

Answer

Cystic fibrosis

Question 10

A graft that has been derived from another species of a different genetic disposition is also known as a:

Accepted Answer

Heterograft

Answer

Allograft

Answer

Isograft

Answer

Homograft

Transplant Surgery — MCQs

Transplant Surgery — MCQs

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