Transplant Surgery Practice Questions

Q: Dr. Christiaan Barnard performed the 1st heart transplant in the year -

1967. ***1967*** - Dr. Christiaan Barnard performed the **first human heart transplant** on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa. - The recipient, Louis Washkansky, lived for 18 days after the surgery. *1962* - While significant advancements in medicine occurred in 1962, the **first heart transplant** had not yet been performed. - This year saw the approval of the **measles vaccine** and the publication of Rachel Carson's "Silent Spring," but not the seminal heart transplant. *1965* - The year 1965 was a period of continued research and experimentation in organ transplantation, but the **first successful human heart transplant** took place later. - Prior to 1967, xenotransplantation experiments in humans involving animal hearts were attempted, but a human-to-human transplant was still pending. *1969* - By 1969, **several hundred heart transplants** had already been performed worldwide following Barnard's pioneering surgery. - Dr. Denton Cooley performed the **first implantation of a total artificial heart** in a human in 1969, indicating that heart transplantation was already established.

Q: All of the following are absolute contraindications for renal transplantation except:

Reduced life expectancy. ***Reduced life expectancy*** - While a significantly reduced life expectancy due to certain **comorbidities** may influence the decision to transplant, it is not an absolute, but rather a relative, contraindication, as individual cases vary. - Ethical considerations and the potential for improved quality of life may still support transplantation in some cases, even with a **limited prognosis**. *Active infection* - An **active systemic infection** is an absolute contraindication due to the high risk of severe complications, including sepsis and infection of the transplanted organ, especially with immunosuppression. - The patient must be free of active infection before transplantation to ensure the safety and success of the procedure. *Active malignancy* - The presence of an **active malignancy** is an absolute contraindication because immunosuppressive therapy post-transplant can accelerate cancer progression and metastasis. - Patients typically require a **disease-free interval** (e.g., 2-5 years) after cancer treatment before being considered for transplantation. *Active drug abuse* - **Active illicit drug abuse** is an absolute contraindication due to concerns about adherence to the complex post-transplant medical regimen, potential for infections, and overall poor health outcomes. - Successful transplantation requires strict adherence to medication schedules and follow-up, which is jeopardized by **active substance use**.

Q: Allopurinol is used in organ preservation as:

Antioxidant. ***Antioxidant*** - Allopurinol acts as a **xanthine oxidase inhibitor**, which reduces the production of **superoxide radicals** during reperfusion injury. - By inhibiting this enzyme, it indirectly limits the formation of harmful **reactive oxygen species**, thereby functioning as an effective antioxidant in organ preservation. *Precursor for energy metabolism* - Allopurinol is an **inhibitor of purine metabolism**, specifically xanthine oxidase, rather than a precursor. - Its metabolic action works against energy production in the context of purine synthesis. *Preservative* - While it aids in organ preservation due to its pharmacological effects, "preservative" is a general term and doesn't specify its mechanism of action. - Its role is targeted at specific biochemical pathways, not broadly as a non-specific preserving agent. *Free radical scavenger* - While allopurinol does reduce free radicals, it does so indirectly by **inhibiting their production**, rather than through direct scavenging. - It prevents the formation of **superoxide anions** by blocking the enzyme responsible for their synthesis, rather than chemically neutralizing existing ones.

Q: Grafts transferred between different species are called

Xenograft. ***Xenograft*** - A **xenograft** refers to the transplantation of organs or tissues between **different species**. - For example, using a **pig heart valve** in a human is a xenograft. *Homograft* - A **homograft** (also known as an allograft) involves tissue transplantation between genetically **non-identical individuals of the same species**. - For instance, a kidney transplant from one human to another unrelated human is a homograft. *Isograft* - An **isograft** is a rare type of transplant where tissue is transferred between **genetically identical individuals** (e.g., identical twins). - Since the individuals are genetically identical, there is no immune rejection. *Allograft* - **Allograft** is synonymous with **homograft**, referring to tissue transplantation between genetically **non-identical individuals of the same species**. - It is the most common type of human-to-human transplant.

Q: Which of the following is an indication of auxiliary partial orthotopic liver transplantation?

Metabolic liver disease. ***Metabolic liver disease*** - **Auxiliary partial orthotopic liver transplantation (APOLT)** is indicated for metabolic liver diseases to provide the necessary enzyme or protein function while potentially allowing the native liver to regenerate. - This procedure involves transplanting a portion of a healthy liver and leaving a portion of the diseased native liver in place. This is especially useful in conditions like **Crigler-Najjar syndrome** or **urea cycle disorders**. *As a standby procedure till a suitable donor is found* - While temporary support can be crucial in acute liver failure, APOLT is a complex surgical procedure, not a simple standby. - **Bridge to transplant** often involves less invasive measures like extracorporeal liver assist devices rather than a partial transplant. *Drug induced hepatic failure* - Drug-induced hepatic failure, if reversible, typically managed with supportive care, and the native liver may recover. - While severe cases might require transplantation, APOLT is generally reserved for conditions requiring ongoing metabolic support where the native liver may eventually recover some function. *All irreversible causes of fulminant liver failure* - For irreversible **fulminant liver failure**, a **full orthotopic liver transplantation** is usually required because the entire native liver needs to be replaced due to extensive and irreversible damage. - APOLT aims to allow the native liver to recover, which is unlikely in cases of irreversible fulminant failure, making a complete replacement necessary.

Q: The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of:

Amylase levels. ***Amylase levels*** - Bladder drainage allows for direct monitoring of **urinary amylase levels**, which serves as a sensitive indicator of pancreatic allograft rejection. A drop in urine amylase activity can quickly signal graft dysfunction or rejection. - This direct measurement in urine is not possible with enteric drainage, where pancreatic enzymes are diverted into the intestines. *Glucose levels* - **Blood glucose levels** are monitored similarly regardless of the drainage type. Both bladder and enteric drainage aim to normalize blood glucose by providing insulin-producing cells. - While pancreatic transplantation aims to normalize glucose, its monitoring is systemic and not specific to the drainage method. *Electrolyte levels* - Monitoring **serum electrolyte levels** is important in all transplant patients, but it is not a specific advantage of bladder drainage over enteric drainage. - Bladder drainage can, in some cases, lead to metabolic complications (e.g., metabolic acidosis due to bicarbonate loss), but this is a potential downside, not an advantage for monitoring per se. *HBA1C levels* - **HbA1c levels** reflect long-term glycemic control (over 2-3 months) and are monitored in both bladder and enteric drained recipients to assess overall success of the transplant in managing diabetes. - HbA1c is a chronic marker, while the advantage of bladder drainage lies in acute monitoring of graft function using amylase.

Q: Dr. Christiaan Barnard is associated with?

Heart transplant. ***Heart transplant*** - **Dr. Christiaan Barnard** performed the **first successful human-to-human heart transplant** on December 3, 1967. - This pioneering surgery cemented his place in medical history and opened new avenues for treating end-stage heart disease. *Hair transplant* - While a significant medical procedure, hair transplantation is primarily associated with dermatological and plastic surgery, not Dr. Christiaan Barnard. - The first successful hair transplant was performed by **Dr. Norman Orentreich** in 1952. *Renal transplantation* - The first successful human organ transplant was a **kidney transplant** performed by **Dr. Joseph Murray** in 1954, for which he received the Nobel Prize. - Although a groundbreaking procedure, it predates Barnard's work and is attributed to different surgical teams. *Liver transplant* - The first successful **liver transplant** was performed by **Dr. Thomas Starzl** in 1967, the same year as Barnard's heart transplant. - While both were monumental achievements in transplantation, they involved different organs and different surgeons.

Q: Most sensitive marker for post-transplant rejection of liver is:

ALT. ***ALT*** - **Alanine aminotransferase (ALT)** is primarily found in the liver and is a highly sensitive indicator of **hepatocellular damage**. [1] - Elevations in ALT often precede other markers in cases of **acute cellular rejection** in liver transplant recipients. *GGT* - **Gamma-glutamyl transferase (GGT)** can be elevated in liver injury, but it is also increased in **biliary obstruction** and due to certain medications like alcohol. [1] - While GGT can be a general marker of liver stress, it is less specific than ALT for hepatocellular rejection. *AST* - **Aspartate aminotransferase (AST)** is found in the liver, heart, skeletal muscle, and kidneys, making it **less specific** to liver injury than ALT. - Although AST levels rise in liver damage, ALT is generally considered a more liver-specific enzyme. *Bilirubin* - **Bilirubin** levels primarily reflect the liver's ability to conjugate and excrete bilirubin, often indicating **cholestasis** or severe hepatocellular dysfunction. - While elevated bilirubin can occur with rejection, it is typically a **later and less sensitive marker** compared to transaminases for early hepatocellular rejection.

Question 1

Dr. Christiaan Barnard performed the 1st heart transplant in the year -

Accepted Answer

1967

Answer

1962

Answer

1965

Answer

1969

Question 2

In discussing the treatment of a 42-year-old man with severe liver cirrhosis, the possibility of heterotopic transplantation is considered. Which statement about heterotopic liver transplantation is TRUE?

Accepted Answer

It should be done in the iliac vessels.

Answer

It is preferable to orthotopic liver transplantation.

Answer

It is rarely associated with long-term survival.

Answer

It implies removal of the recipient's liver.

Question 3

All of the following are absolute contraindications for renal transplantation except:

Accepted Answer

Reduced life expectancy

Answer

Active infection

Answer

Active malignancy

Answer

Active drug abuse

Question 4

In orthotopic liver transplantation, which is the best way to achieve bile drainage in the donor liver

Accepted Answer

Donor bile duct with recipient bile duct or Roux-en-Y choledochojejunostomy

Answer

Donor bile duct with jejunum of recipient

Answer

Donor bile duct with duodenum of recipient

Answer

External drainage for a few days followed by choledochojejunostomy

Question 5

Allopurinol is used in organ preservation as:

Accepted Answer

Antioxidant

Answer

Precursor for energy metabolism

Answer

Preservative

Answer

Free radical scavenger

Question 6

Grafts transferred between different species are called

Accepted Answer

Xenograft

Answer

Homograft

Answer

Isograft

Answer

Allograft

Question 7

Which of the following is an indication of auxiliary partial orthotopic liver transplantation?

Accepted Answer

Metabolic liver disease

Answer

As a standby procedure till a suitable donor is found

Answer

Drug induced hepatic failure

Answer

All irreversible causes of fulminant liver failure

Question 8

The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of:

Accepted Answer

Amylase levels

Answer

Glucose levels

Answer

Electrolyte levels

Answer

HBA1C levels

Question 9

Dr. Christiaan Barnard is associated with?

Accepted Answer

Heart transplant

Answer

Hair transplant

Answer

Renal transplantation

Answer

Liver transplant

Question 10

Most sensitive marker for post-transplant rejection of liver is:

Accepted Answer

ALT

Answer

GGT

Answer

AST

Answer

Bilirubin

Transplant Surgery — MCQs

Transplant Surgery — MCQs

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