Transplant Surgery — MCQs

Transplant Surgery Indian Medical PG Practice Questions and MCQs

Question 101: Which of the following diseases is appropriately treated with combined heart-lung transplantation?

A. End-stage emphysema
B. Idiopathic dilated cardiomyopathy with long-standing secondary pulmonary hypertension (Correct Answer)
C. Primary pulmonary hypertension
D. Cystic fibrosis

Explanation: ***Idiopathic dilated cardiomyopathy with long-standing secondary pulmonary hypertension*** - In cases of severe **idiopathic dilated cardiomyopathy**, the failing left ventricle can lead to **long-standing secondary pulmonary hypertension**. - This persistent high pressure in the pulmonary circulation results in **irreversible damage** to the pulmonary vasculature, creating fixed pulmonary vascular resistance. - When the pulmonary hypertension becomes fixed and irreversible, isolated heart transplantation would fail as the new heart would face the same elevated pressures, necessitating **combined heart-lung transplantation**. *End-stage emphysema* - **End-stage emphysema** primarily affects the lungs, causing destruction of alveolar walls and airflow obstruction. - While a **bilateral lung transplant** is the standard treatment for severe emphysema, the heart is typically not primarily affected to the extent that it would require combined transplantation. *Primary pulmonary hypertension* - **Primary pulmonary hypertension** is a disease of the pulmonary arteries, where blood vessels in the lungs become narrowed, stiff, or destroyed. - In most cases, **bilateral lung transplantation** alone is sufficient, as the new lungs provide healthy pulmonary vasculature. - While combined heart-lung transplantation may be considered in severe cases with established irreversible right ventricular failure, the more definitive indication is when secondary pulmonary hypertension is caused by primary cardiac disease (as in option A). *Cystic fibrosis* - **Cystic fibrosis** is a genetic disorder that predominantly causes severe lung disease due to thick, sticky mucus buildup. - It primarily necessitates a **bilateral lung transplant** to replace the diseased lungs; the heart is generally not directly affected to the point of requiring a combined transplant.

Question 102: A graft that has been derived from another species of a different genetic disposition is also known as a:

A. Allograft
B. Isograft
C. Heterograft (Correct Answer)
D. Homograft

Explanation: ***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 103: Dr. Christiaan Barnard performed the 1st heart transplant in the year -

A. 1962
B. 1965
C. 1969
D. 1967 (Correct Answer)

Explanation: ***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.

Question 104: 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?

A. It is preferable to orthotopic liver transplantation.
B. It is rarely associated with long-term survival.
C. It implies removal of the recipient's liver.
D. It should be done in the iliac vessels. (Correct Answer)

Explanation: ***It should be done in the iliac vessels.*** - **Heterotopic liver transplantation** involves placing the donor liver in an ectopic location (typically in the right lower abdomen or pelvis) while the native liver remains in situ. - Vascular anastomosis is commonly performed using the **iliac vessels** (external or common iliac artery and vein) or infrarenal IVC and aorta for blood supply to the graft. - This is a **largely historical procedure** that has been mostly abandoned due to technical complexity, high complication rates, and poor long-term outcomes compared to orthotopic transplantation. *It is preferable to orthotopic liver transplantation.* - **Orthotopic liver transplantation (OLT)**, where the diseased liver is completely removed and replaced, is the **gold standard** for end-stage liver disease. - OLT provides superior long-term outcomes, complete removal of the diseased organ, and eliminates competition between native and donor liver function. - Heterotopic transplantation is **not preferable** and has been largely abandoned in modern practice. *It is rarely associated with long-term survival.* - This statement has historical validity—heterotopic liver transplantation was indeed associated with **poor long-term outcomes**, which is a major reason the procedure was largely discontinued. - Complications included vascular thrombosis, competition between native and donor liver, portal hypertension, and technical difficulties. - However, in the context of this question, the statement about iliac vessels is more specifically correct regarding the technical aspect of the procedure. *It implies removal of the recipient's liver.* - **Incorrect**—the defining feature of **heterotopic transplantation** is that the **native liver is left in place**. - Removal of the recipient's liver is characteristic of **orthotopic liver transplantation**, where the diseased organ is excised and replaced in the same anatomical location.

Question 105: All of the following are absolute contraindications for renal transplantation except:

A. Active infection
B. Active malignancy
C. Active drug abuse
D. Reduced life expectancy (Correct Answer)

Explanation: ***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**.

Question 106: In orthotopic liver transplantation, which is the best way to achieve bile drainage in the donor liver

A. Donor bile duct with recipient bile duct or Roux-en-Y choledochojejunostomy (Correct Answer)
B. Donor bile duct with jejunum of recipient
C. Donor bile duct with duodenum of recipient
D. External drainage for a few days followed by choledochojejunostomy

Explanation: ***Donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy*** - The most common and preferred method for bile drainage in **orthotopic liver transplantation** is a **duct-to-duct anastomosis** between the donor and recipient bile ducts. - If a primary duct-to-duct anastomosis is not feasible due to size mismatch, damage, or other reasons, a **Roux-en-Y choledochojejunostomy** is performed, which involves connecting the donor bile duct to a Roux limb of the jejunum. *External drainage for few days followed by choledochojejunostomy* - **External bile drainage** is generally avoided in liver transplantation due to increased risks of **infection** and complications like **bile leaks**. - It does not provide a definitive long-term solution for bile flow and necessitates a secondary, more complex surgical procedure for permanent drainage. *Donor bile duct with jejunum of recipient* - Connecting the donor bile duct directly to the jejunum (without a Roux-en-Y limb) would expose the biliary tree to **intestinal contents**, increasing the risk of **ascending cholangitis**. - The Roux-en-Y configuration is crucial to prevent reflux of food and bacteria into the biliary system, which is not achieved by a simple choledochojejunostomy. *Donor bile duct with duodenum of recipient* - Anastomosing the donor bile duct directly to the **duodenum** significantly increases the risk of **reflux of duodenal contents**, including digestive enzymes and bacteria, into the biliary system. - This reflux can lead to severe and recurrent **cholangitis**, stricture formation, and potential graft failure due to chronic inflammation and infection.

Question 107: What is a xenograft?

A. Graft from 1 species to other species (Correct Answer)
B. Graft from sister to brother
C. Graft from father to other child
D. Graft from 1 twin to other twin

Explanation: ***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.

Question 108: Grafts transferred between different species are called

A. Homograft
B. Xenograft (Correct Answer)
C. Isograft
D. Allograft

Explanation: ***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.

Question 109: Which of the following is an indication of auxiliary partial orthotopic liver transplantation?

A. As a standby procedure till a suitable donor is found
B. Metabolic liver disease (Correct Answer)
C. Drug induced hepatic failure
D. All irreversible causes of fulminant liver failure

Explanation: ***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.

Question 110: The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of:

A. Amylase levels (Correct Answer)
B. Glucose levels
C. Electrolyte levels
D. HBA1C levels

Explanation: ***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.

Practice by Chapter

Immunology of Transplantation

Practice Questions

Immunosuppression

Practice Questions

Organ Procurement

Practice Questions

Kidney Transplantation

Practice Questions

Liver Transplantation

Practice Questions

Pancreas Transplantation

Practice Questions

Heart Transplantation

Practice Questions

Lung Transplantation

Practice Questions

Small Bowel Transplantation

Practice Questions

Complications of Transplantation

Practice Questions

Transplantation in Special Populations

Practice Questions

Ethical Issues in Transplantation

Practice Questions

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