Transplant Surgery — MCQs

Transplant Surgery Indian Medical PG Practice Questions and MCQs

Question 111: Dr. Christiaan Barnard is associated with?

A. Hair transplant
B. Renal transplantation
C. Liver transplant
D. Heart transplant (Correct Answer)

Explanation: ***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.

Question 112: What is the primary indication for kidney transplantation?

A. End-stage renal disease (Correct Answer)
B. Acute kidney injury
C. Polycystic kidney disease
D. Chronic pyelonephritis

Explanation: ***End-stage renal disease*** - Kidney transplantation is primarily indicated for patients with **end-stage renal disease (ESRD)**, as it offers the best chance for long-term survival and improved quality of life compared to dialysis. - ESRD is the final stage of chronic kidney disease, where the kidneys have permanently failed and are no longer able to filter waste products from the blood adequately. *Acute kidney injury* - **Acute kidney injury (AKI)** is a sudden and often reversible loss of kidney function, which is typically managed with supportive care or temporary dialysis, not transplantation. - AKI is different from chronic kidney failure and may resolve with appropriate treatment of the underlying cause. *Polycystic kidney disease* - While **polycystic kidney disease (PKD)** can lead to ESRD, it is the resulting ESRD, not PKD itself, that is the direct indication for transplantation. - PKD is a **genetic disorder** causing fluid-filled cysts to grow in the kidneys, eventually impairing kidney function. *Chronic pyelonephritis* - **Chronic pyelonephritis** is a severe bacterial infection of the kidneys, which can cause scarring and lead to chronic kidney disease or ESRD over time. - Similar to PKD, it is the progression to **ESRD**, rather than the infection itself, that necessitates kidney transplantation.

Question 113: During a kidney transplant, which anatomical landmark is crucial for the correct positioning of the renal artery?

A. External iliac vessels (Correct Answer)
B. Aortic bifurcation
C. Superior mesenteric artery
D. Inferior mesenteric artery

Explanation: ***External iliac vessels*** - The **external iliac artery** is the primary vascular landmark for kidney transplantation and serves as the recipient vessel for anastomosis of the donor renal artery. - In renal transplantation, the donor renal artery is typically anastomosed **end-to-side** to the recipient's external iliac artery, while the renal vein is connected to the external iliac vein. - The transplanted kidney is positioned in the **iliac fossa**, and the external iliac vessels provide the essential vascular supply with adequate blood flow and appropriate vessel caliber for anastomosis. - This is the **standard surgical technique** for renal transplantation in adults. *Aortic bifurcation* - The **aortic bifurcation** is where the abdominal aorta divides into the right and left common iliac arteries at approximately the **L4 vertebral level**. - While it is an important vascular landmark, it is located **too proximal** and too high in the abdomen for the typical transplant site in the iliac fossa. - Direct anastomosis to the aorta is rarely performed and would be technically more challenging. *Superior mesenteric artery* - The **superior mesenteric artery (SMA)** is a major branch of the abdominal aorta that supplies blood to the midgut structures. - It is **not relevant** to kidney transplant surgery, as it is located too high in the abdomen and supplies the intestines, not the pelvic region where transplants are performed. *Inferior mesenteric artery* - The **inferior mesenteric artery (IMA)** arises from the aorta and supplies the hindgut (descending colon, sigmoid, and upper rectum). - Like the SMA, it is **not a landmark** for renal transplantation and has no role in the vascular anastomosis required for kidney transplant surgery.

Question 114: A patient has undergone kidney transplantation. What is the most critical concern in the early postoperative period that can lead to graft loss?

A. Graft rejection (Correct Answer)
B. Infection
C. Delayed graft function
D. Vascular thrombosis

Explanation: ***Graft rejection*** - **Graft rejection** is the most critical concern that can lead to graft loss in the postoperative period, as the recipient's immune system recognizes the transplanted kidney as foreign tissue and mounts an immune response. - **Hyperacute rejection** (rare with modern crossmatching) occurs within minutes to hours; **acute rejection** typically occurs within the first 3-6 months and requires immediate immunosuppressive therapy. - Uncontrolled rejection leads to irreversible graft damage and loss, making immunosuppression monitoring critical. *Infection* - **Infection** is a major complication due to immunosuppression and can be life-threatening, but is generally manageable with antimicrobial therapy. - While serious, infections do not directly cause graft loss in the same manner as immunologic rejection, though severe infections may require reducing immunosuppression. *Delayed graft function* - **Delayed graft function (DGF)** occurs in 20-40% of deceased donor transplants, requiring dialysis in the first week post-transplant. - While DGF increases acute rejection risk and affects long-term outcomes, it often resolves spontaneously and doesn't represent an immediate immunologic threat to the graft. *Vascular thrombosis* - **Vascular thrombosis** (arterial or venous) is a surgical emergency occurring in 1-5% of cases, typically within the first 48 hours. - While it causes immediate graft loss if not recognized promptly, it is less common than rejection episodes overall, and represents a technical rather than immunologic complication.

Question 115: In lung transplant candidate evaluation, which factor is considered most fundamental in determining transplant urgency and potential benefit?

A. Severity of underlying lung disease (Correct Answer)
B. Current functional status
C. Potential for rehabilitation
D. Patient's socioeconomic status

Explanation: ***Severity of underlying lung disease*** - This factor is paramount because it dictates the **degree of physiologic impairment** and the **rate of disease progression**, directly influencing the **urgency of transplantation** to prevent irreversible organ damage or death. - The severity of the disease also determines the **potential for meaningful clinical benefit** post-transplant, as patients with advanced disease are more likely to experience improved quality of life and survival. *Current functional status* - While important for assessing a patient's immediate capabilities and predicting post-transplant recovery, functional status is often a **consequence of the underlying disease severity**. - It provides a snapshot of the patient's current condition but doesn't inherently predict the **future trajectory or urgency** of the need for transplant as directly as disease severity does. *Potential for rehabilitation* - This refers to the patient's capacity to benefit from physical therapy and other interventions after surgery, which is crucial for **successful recovery and long-term outcomes**. - However, the ability to rehabilitate is a **determinant of transplant suitability**, not the primary factor for identifying the **initial need or urgency** for the transplant itself. *Patient's socioeconomic status* - Socioeconomic status can influence access to care, adherence to medical regimens, and the availability of support systems, all of which are important for **post-transplant success**. - It is an **ethical consideration** and a factor in holistic patient care, but it does not directly determine the **medical necessity or urgency** of a lung transplant.

Question 116: What type of graft is represented by the scenario of a mother donating a kidney to her son?

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

Explanation: ***Allograft (Correct Answer)*** - An **allograft** (also called a homograft) is a graft of tissue or an organ transplanted between two genetically different individuals of the same species. - In this scenario, a mother donating a kidney to her son represents transplantation between two humans (same species) who are genetically related but not genetically identical. - This is the classic example of an **allograft** - the most common type of transplant in clinical practice. *Incorrect: Isograft* - An **isograft** (also called a syngeneic graft) is a special type of allograft where the donor and recipient are genetically identical, such as monozygotic (identical) twins. - A mother and son share approximately 50% of their genes but are not genetically identical, so this does not qualify as an isograft. - Isografts have the advantage of no rejection risk due to genetic identity. *Incorrect: Autograft* - An **autograft** is a graft of tissue from one site to another site within the same individual's body. - Examples include skin grafts from thigh to burn areas, or saphenous vein grafts for coronary artery bypass. - Since this scenario involves two different individuals (mother and son), it cannot be an autograft. *Incorrect: Xenograft* - A **xenograft** (also called a heterograft) is a graft transplanted between members of different species. - Examples include porcine (pig) heart valves used in humans, or temporary porcine skin grafts for burn patients. - Since both mother and son are humans (same species - *Homo sapiens*), this is not a xenograft.

Question 117: What is the purpose of the Milan criteria?

A. Selecting patients for heart transplantation
B. Selecting patients for Liver transplantation (Correct Answer)
C. Selecting patients for Lung transplantation
D. Selecting patients for Kidney transplantation

Explanation: ***Selecting patients for Liver transplantation*** - The **Milan criteria** are specifically used to determine which patients with **hepatocellular carcinoma (HCC)** are eligible for **liver transplantation**. - These criteria define tumor size and number limits (e.g., a single lesion ≤ 5 cm or up to 3 lesions with no lesion > 3 cm) to predict post-transplant survival. *Selecting patients for Lung transplantation* - **Lung transplantation** eligibility is typically guided by criteria related to lung disease severity, such as the **Lung Allocation Score (LAS)**, not the Milan criteria. - The primary aim is to assess the risk of death without transplantation versus the potential benefit of a transplant. *Selecting patients for Kidney transplantation* - **Kidney transplantation** selection is based on factors like **end-stage renal disease**, overall health status, and absence of significant co-morbidities, primarily using the **Kidney Allocation System (KAS)**. - Eligibility does not involve tumor-specific criteria like those in the Milan criteria. *Selecting patients for heart transplantation* - Selection for **heart transplantation** involves evaluating patients with **end-stage heart failure** who have limited treatment options and a high risk of mortality, often using criteria like MELD or UNOS scores, not the Milan criteria. - Factors like functional status, pulmonary vascular resistance, and co-morbidities are key considerations.

Question 118: Who first performed liver transplantation?

A. Christian Barnard
B. Starzl (Correct Answer)
C. Carrel
D. Huggins

Explanation: ***Starzl*** - **Thomas E. Starzl** performed the first human liver transplant in **1963** and the first successful long-term liver transplant in **1967**. - He is widely recognized as the **father of modern transplantation** for his pioneering work in liver transplantation and immunosuppression. *Huggins* - **Charles Brenton Huggins** was a Nobel Prize-winning physician known for his work on the hormonal treatment of **prostate cancer**. - His contributions were primarily in **oncology** and endocrinology, not liver transplantation. *Carrel* - **Alexis Carrel** was a French surgeon and biologist who won the Nobel Prize for his work on **vascular suturing** and organ transplantation techniques in the early 20th century. - While he laid foundational work for transplantation, he did not perform the first liver transplant. *Christian Barnard* - **Christian Barnard** was a South African cardiac surgeon who performed the **world's first human-to-human heart transplant** in **1967**. - His pioneering work was in cardiac surgery, not liver transplantation.

Question 119: Which of the following is NOT an indication for liver transplantation?

A. Sclerosing cholangitis
B. Cirrhosis
C. Biliary atresia
D. Hepatitis A (Correct Answer)

Explanation: ***Hepatitis A*** - **Hepatitis A** is typically an **acute, self-limiting viral infection** of the liver, and the vast majority of patients recover completely without chronic liver damage or the need for transplantation. - While rare cases of **fulminant hepatic failure** due to Hepatitis A can occur, requiring transplantation, it is not a routine indication for transplantation in its usual course. *Biliary atresia* - **Biliary atresia** is a common indication for **pediatric liver transplantation**, as it causes progressive destruction of the bile ducts leading to cholestasis and cirrhosis. - If initial surgical interventions like the **Kasai procedure** fail, liver transplantation becomes necessary to survive. *Sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic, progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricturing of the bile ducts. - This leads to **cirrhosis, liver failure, and an increased risk of cholangiocarcinoma**, making liver transplantation a definitive treatment. *Cirrhosis* - **Cirrhosis** from various etiologies (e.g., chronic hepatitis B/C, alcoholic liver disease, non-alcoholic steatohepatitis) is the **most common indication for liver transplantation** worldwide. - Patients with **decompensated cirrhosis** (e.g., ascites, encephalopathy, variceal bleeding) and those with **hepatocellular carcinoma** within Milan criteria are primary candidates for transplantation.

Question 120: Which of the following statements about heart transplantation is false?

A. High pulmonary arterial resistance is a contraindication
B. It is only orthotopic and not heterotopic (Correct Answer)
C. Immunosuppression is started preoperatively
D. A beating heart cadaver/donor is not always needed.

Explanation: ***It is only orthotopic and not heterotopic*** - This statement is **FALSE**, making it the correct answer to this question asking for the false statement. - While **orthotopic transplantation** (replacing the recipient's heart with the donor heart in its normal anatomical position) is the overwhelmingly predominant method, **heterotopic transplantation** (leaving the recipient's heart in place and implanting the donor heart as an auxiliary "piggyback" pump) has been performed as an alternative technique. - Heterotopic transplantation, though rarely used in modern practice, was described and performed in select cases, particularly when the donor heart is undersized or when severe pulmonary hypertension is present. Therefore, the claim that heart transplantation is "only orthotopic" is incorrect. *Immunosuppression is started preoperatively* - This statement is **TRUE**. - **Immunosuppressive therapy** is typically initiated intraoperatively or in some protocols may begin preoperatively to prevent hyperacute and acute rejection. - Induction immunosuppression aims to suppress the recipient's immune response before it can react to the transplanted organ, improving early graft survival. *High pulmonary arterial resistance is a contraindication* - This statement is **TRUE**. - **Fixed pulmonary hypertension** with elevated pulmonary vascular resistance (PVR >4-5 Wood units or transpulmonary gradient >15 mmHg unresponsive to vasodilators) is a **contraindication** for isolated heart transplantation. - The donor right ventricle may not be able to pump against high pulmonary pressures, leading to acute right heart failure. - Such patients may require combined heart-lung transplantation or medical optimization to reduce pulmonary vascular resistance before transplantation can be considered. *A beating heart cadaver/donor is not always needed* - This statement is considered **TRUE**, though with important caveats. - Traditionally, heart transplantation has relied almost exclusively on **beating-heart donors** (brain-dead donors with maintained cardiac function) to ensure organ viability. - The statement acknowledges that in rare circumstances or with advanced preservation techniques, the absolute requirement for a beating heart might be questioned, though in practical terms beating-heart donation remains the standard for heart transplantation.

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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