Transplant Surgery Practice Questions

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**.

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: What is a xenograft?

Graft from 1 species to other species. ***Graft from 1 species to other species*** - A **xenograft**, also known as a **heterograft**, is defined as the transplantation of organs or tissues from one species to another. - Examples include using **porcine (pig)** heart valves in human patients or transplanting baboon hearts into human infants, though the latter is rarely done now due to ethical issues and immunological rejection. *Graft from sister to brother* - This describes an **allograft**, also known as a **homograft**, which is a transplant between genetically different individuals of the same species. - While genetically related, a sister and brother are not genetically identical, thus requiring some degree of **immunosuppression** to prevent rejection. *Graft from father to other child* - This is also an **allograft** or **homograft**, as it involves transplantation between genetically distinct individuals of the same species. - The degree of genetic match would be moderate, similar to a sibling transplant but with potentially more **HLA mismatches**. *Graft from 1 twin to other twin* - This is an **isograft**, also known as an **isogenic graft**, and refers to a transplant between genetically identical individuals, such as identical twins. - Such grafts typically do not elicit an immune response, as the donor and recipient share the exact same **MHC (HLA)** antigens.

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.

Question 1

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 2

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

Question 3

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

Accepted Answer

1967

Answer

1962

Answer

1965

Answer

1969

Question 4

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 5

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 6

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 7

What is a xenograft?

Accepted Answer

Graft from 1 species to other species

Answer

Graft from sister to brother

Answer

Graft from father to other child

Answer

Graft from 1 twin to other twin

Question 8

Grafts transferred between different species are called

Accepted Answer

Xenograft

Answer

Homograft

Answer

Isograft

Answer

Allograft

Question 9

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 10

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

Transplant Surgery — MCQs

Transplant Surgery — MCQs

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