CCTN review Exam Questions with Correct
Solutions
Procedure for liver transplant - ANSWER Anastomosis of the inferior vena cava, portal vein,
hepatic artery, and the biliary connection via a duct to duct anastomosis (
choledochocholeclochostomy)
Etiology of renal dysfunction immediately post op(liver tx) - ANSWER Hypotensive episodes,
blood loss, high renal vein pressure intraoperatively and postoperatively due to
hemodynamically instability or sepsis.
Leading cause of non graft related death for liver recipients - ANSWER Cardiorespiratory failure
Which immunosuppressants cause HTN - ANSWER Calcineurin inhibitors or corticosteroids
Which lab to monitor with fever post tx - ANSWER Crp- c reactive protein because protein
present with acute inflammation and sepsis
Indicative of rejection - ANSWER Light stools and dark urine,
Indicative of poor graft function s/p liver transplant - ANSWER High lactate and acidosis, high
ALT/AST, PT >25 sec and continues to rise after vit k and FFP
type 2 diabetes - ANSWER More common, occurs in adulthood, characterized by insulin
resistance. As resistance rise, beta cells are eventually unable to produce necessary amount of
insulin to lower and maintain normal blood glucose levels.
type 1 diabetes mellitus - ANSWER diabetes in which no beta-cell production of insulin occurs
and the patient is dependent on insulin for survival
,Goal of pancreas transplant - ANSWER To restore normoglycemia, halt or prevent secondary
complications of diabetes
Indications for pancreas transplant alone (PTA) or pancreas after kidney (PAK) transplant -
ANSWER Type 1 DM manifested by poor metabolic control, especially hypoglycemic
unawareness for many years. On insulin and C-peptide at or < 2 ng/ml or on insulin and C-
peptide at or greater than 2ng/mg and BMI at or less than maximum allowable BMI (currently
28) and pancreatic exocrine insufficiency.
Indications for Simultaneous pancreas-kidney (SPK) transplant - ANSWER Diagnosis of diabetes
or pancreatic exocrine insufficiency with renal insufficiency
Immunosuppressive medications are covered by which part of Medicare? - ANSWER Medicare
part B
Standard immunosuppressive for pancreas transplant recipients typically includes: - ANSWER
Tacrolimus(prograf, FK506), mycophenolate mofetil (cellcept), prednisone(steroid)
Reason why native pancreas left in place during pancreas tx - ANSWER Allows the exocrine
function of native pancreas to be preserved.
Enteric Drainage( ED) post pancreas transplant - ANSWER More common, difficult to detect
rejection, donor portal vein anastomosed to recipients SMV(superior mesenteric vein), donor
duodenal segment attached to recipients jejunum, pancreases produces 2L of fluid drainage,
pancreatic enzymes excreted thru the stool
Advantages of Enteric drain (ED) post pancreas transplant - ANSWER More physiologic, fewer
metabolic imbalances because pancreatic secretions are reabsorbed, less post-op complications
Bladder Drainage (BD) post pancreas transplant - ANSWER Easier to monitor for rejection with
urine amylase, may cause dehydration and cystitis. Direct monitoring of graft exocrine function,
easier to perform biopsy, less invasive if complications arise.
, Disadvantages of Bladder Drainage (BD) post pancreas transplant - ANSWER Dehydration,
cystitis, UTIs, metabolic acidosis, urine leak, hematuria, 35% go on to need enteric conversion,
pancreatitis
Patients with anastomotic leak post pancreas transplant may present with what? - ANSWER
Elevated serum amylase levels
C-peptide normal range - ANSWER 0.8-3.1
What is a sign of late rejection post pancreas transplant? - ANSWER Hyperglycemia
Patients with chronic pancreas rejection can present with what? - ANSWER Progressive need
for insulin
In pancreas transplant recipients temperature elevations may indicate what? - ANSWER
Infection, pancreatitis, acute rejection
Cvp range post pancreas transplant - ANSWER 5-10
When should you notify transplant team in regards to urine output s/p pancreas transplant -
ANSWER Urine output <50 and >200 ml/hr in the first 24hrs post tx
Why is it important for adequate perfusion of graft post pancreas tx - ANSWER Pancreas graft is
"low blood flow" organ higher potential for graft thrombosis
Which rejection is more common in PTA patients? - ANSWER Acute happens earlier and more
frequent
Solutions
Procedure for liver transplant - ANSWER Anastomosis of the inferior vena cava, portal vein,
hepatic artery, and the biliary connection via a duct to duct anastomosis (
choledochocholeclochostomy)
Etiology of renal dysfunction immediately post op(liver tx) - ANSWER Hypotensive episodes,
blood loss, high renal vein pressure intraoperatively and postoperatively due to
hemodynamically instability or sepsis.
Leading cause of non graft related death for liver recipients - ANSWER Cardiorespiratory failure
Which immunosuppressants cause HTN - ANSWER Calcineurin inhibitors or corticosteroids
Which lab to monitor with fever post tx - ANSWER Crp- c reactive protein because protein
present with acute inflammation and sepsis
Indicative of rejection - ANSWER Light stools and dark urine,
Indicative of poor graft function s/p liver transplant - ANSWER High lactate and acidosis, high
ALT/AST, PT >25 sec and continues to rise after vit k and FFP
type 2 diabetes - ANSWER More common, occurs in adulthood, characterized by insulin
resistance. As resistance rise, beta cells are eventually unable to produce necessary amount of
insulin to lower and maintain normal blood glucose levels.
type 1 diabetes mellitus - ANSWER diabetes in which no beta-cell production of insulin occurs
and the patient is dependent on insulin for survival
,Goal of pancreas transplant - ANSWER To restore normoglycemia, halt or prevent secondary
complications of diabetes
Indications for pancreas transplant alone (PTA) or pancreas after kidney (PAK) transplant -
ANSWER Type 1 DM manifested by poor metabolic control, especially hypoglycemic
unawareness for many years. On insulin and C-peptide at or < 2 ng/ml or on insulin and C-
peptide at or greater than 2ng/mg and BMI at or less than maximum allowable BMI (currently
28) and pancreatic exocrine insufficiency.
Indications for Simultaneous pancreas-kidney (SPK) transplant - ANSWER Diagnosis of diabetes
or pancreatic exocrine insufficiency with renal insufficiency
Immunosuppressive medications are covered by which part of Medicare? - ANSWER Medicare
part B
Standard immunosuppressive for pancreas transplant recipients typically includes: - ANSWER
Tacrolimus(prograf, FK506), mycophenolate mofetil (cellcept), prednisone(steroid)
Reason why native pancreas left in place during pancreas tx - ANSWER Allows the exocrine
function of native pancreas to be preserved.
Enteric Drainage( ED) post pancreas transplant - ANSWER More common, difficult to detect
rejection, donor portal vein anastomosed to recipients SMV(superior mesenteric vein), donor
duodenal segment attached to recipients jejunum, pancreases produces 2L of fluid drainage,
pancreatic enzymes excreted thru the stool
Advantages of Enteric drain (ED) post pancreas transplant - ANSWER More physiologic, fewer
metabolic imbalances because pancreatic secretions are reabsorbed, less post-op complications
Bladder Drainage (BD) post pancreas transplant - ANSWER Easier to monitor for rejection with
urine amylase, may cause dehydration and cystitis. Direct monitoring of graft exocrine function,
easier to perform biopsy, less invasive if complications arise.
, Disadvantages of Bladder Drainage (BD) post pancreas transplant - ANSWER Dehydration,
cystitis, UTIs, metabolic acidosis, urine leak, hematuria, 35% go on to need enteric conversion,
pancreatitis
Patients with anastomotic leak post pancreas transplant may present with what? - ANSWER
Elevated serum amylase levels
C-peptide normal range - ANSWER 0.8-3.1
What is a sign of late rejection post pancreas transplant? - ANSWER Hyperglycemia
Patients with chronic pancreas rejection can present with what? - ANSWER Progressive need
for insulin
In pancreas transplant recipients temperature elevations may indicate what? - ANSWER
Infection, pancreatitis, acute rejection
Cvp range post pancreas transplant - ANSWER 5-10
When should you notify transplant team in regards to urine output s/p pancreas transplant -
ANSWER Urine output <50 and >200 ml/hr in the first 24hrs post tx
Why is it important for adequate perfusion of graft post pancreas tx - ANSWER Pancreas graft is
"low blood flow" organ higher potential for graft thrombosis
Which rejection is more common in PTA patients? - ANSWER Acute happens earlier and more
frequent
