CCTN Transplant Certification Exam Prep
Questions with Correct Solutions
what are some organ donor risk factors - ANSWER medical, social hx related to age of donor
condition of the organ
disease transmission ( human immunodeficiancy virus, hepatitis B, and hepatitis C, cancer,
malaria, disease not detectable at the time of transplant)
What is the standard immunosuppression used - ANSWER Prograf, cellcept, prednisione
Do the doctors remove native kidneys or pancreas? - ANSWER No, this allows the
exocrine function of the native pancreas to be preserved
what are the two surgical approaches to handle exocrine secretions produced by
the transplanted pancreas - ANSWER Enteric drainage (bowel drainage)
Bladder drainage
what happens when the surgeon does enteric drainage to manage exocrine secretions and
what is the benefit of the drainage - ANSWER About 2L of the enzymatic fluid and
bicarbonate produced by the pancreas is reabsorbed in the bowel
The donor portal vein is anastomosed to the side of the recipient's superior mesenteric
vein, the transplanted donor duodenal segment is attached to the recipient's jejunum to
establish exocrine drainage
Benefits of ED drainage: is that no fluid and electrolyte changes occur post-transplant due to its
similarity to the natural anatomy
what happens when the doctor does bladder drainage and what are the benefits - ANSWER This
directs venous outflow and insulin drainage into the iliac vein, exocrine drainage is via
anastomosis of a donor duodenal segment to the recipients urinary bladder
,Benefits is that rejection episodes in the pancreas can be detected more readily by
measuring the exocrine enzyme amylase in the urine
With bladder drainage what complications might occur? - ANSWER dehydration
UTIs ( more so if the patient has a neurogenic bladder)
cystitis
metabolic acidosis ( large amounts of sodium bicarb are emptied into the bladder)
reflux pancreatitis
hematuria
Between bladder drainage and enteric drainage what is used more frequently
If the pancreas and kidney are both transplanted what can serve as early detection factor for
rejection - ANSWER most centers use enteric drainage
the kidney tx
what is the average length of the surgical procedure for a combined kidney and pancreas tx
and an isolated pancreas tx - ANSWER Combined: 4-8 hours
Isolated: 3-4 hours
What is the average length of stay - ANSWER 7-14 days
Pancreas anti- rejection medications - ANSWER depends on the transplant center, most
have triple therapy agents
Tacrolimus (Prograf) - ANSWER Calcineurin inhibitor: Calcineurin is an enzyme that activates T-
cells of the immune system
, Mycophenolate mofetil (cellcept) or mycophenolic acid (Myfortic) - ANSWER An anti-
proliferative agent: inhibit cell-cycle pathways to limit T- and B-cell proliferation and thereby
reducing the cytotoxic response directed toward the cardiac allograft.
Methylprednisolone (Solu medrol) - ANSWER Corticosteroid: lowers immune response
Sirolimus (Rapamycin/Rapamune) - ANSWER Can be used for some patients in lieu of a
calcineurin inhibitor to minimize the nephrotoxic effects associated with calcineurin inhibitors
What two meds will the patients be on long term and which ones will taper off? - ANSWER
Prograf/ Cellcept
patients will taper off prednisone
To avoid the effects of steriods what other medications can we use to avoid incrasesing
blood glucose levels - ANSWER Basilizimab (Simulect) monocolonal antibody
Alemtuzumab (Campath) moncolonal antibody
Antilymphocyte globulin ( Thymo) Polyclonal antibody
What cares should be expected..... - ANSWER OUT OF BED postop day 1
incision care: staples and sutures will remain for approx 3 weeks after surgery
psychosocial needs
education!
What are some of the Post transplant assessment and monitoring - ANSWER Cardiovascular
status
fluid and electrolyte balance
metabolic function
pancreatic graft function
Vitals
Questions with Correct Solutions
what are some organ donor risk factors - ANSWER medical, social hx related to age of donor
condition of the organ
disease transmission ( human immunodeficiancy virus, hepatitis B, and hepatitis C, cancer,
malaria, disease not detectable at the time of transplant)
What is the standard immunosuppression used - ANSWER Prograf, cellcept, prednisione
Do the doctors remove native kidneys or pancreas? - ANSWER No, this allows the
exocrine function of the native pancreas to be preserved
what are the two surgical approaches to handle exocrine secretions produced by
the transplanted pancreas - ANSWER Enteric drainage (bowel drainage)
Bladder drainage
what happens when the surgeon does enteric drainage to manage exocrine secretions and
what is the benefit of the drainage - ANSWER About 2L of the enzymatic fluid and
bicarbonate produced by the pancreas is reabsorbed in the bowel
The donor portal vein is anastomosed to the side of the recipient's superior mesenteric
vein, the transplanted donor duodenal segment is attached to the recipient's jejunum to
establish exocrine drainage
Benefits of ED drainage: is that no fluid and electrolyte changes occur post-transplant due to its
similarity to the natural anatomy
what happens when the doctor does bladder drainage and what are the benefits - ANSWER This
directs venous outflow and insulin drainage into the iliac vein, exocrine drainage is via
anastomosis of a donor duodenal segment to the recipients urinary bladder
,Benefits is that rejection episodes in the pancreas can be detected more readily by
measuring the exocrine enzyme amylase in the urine
With bladder drainage what complications might occur? - ANSWER dehydration
UTIs ( more so if the patient has a neurogenic bladder)
cystitis
metabolic acidosis ( large amounts of sodium bicarb are emptied into the bladder)
reflux pancreatitis
hematuria
Between bladder drainage and enteric drainage what is used more frequently
If the pancreas and kidney are both transplanted what can serve as early detection factor for
rejection - ANSWER most centers use enteric drainage
the kidney tx
what is the average length of the surgical procedure for a combined kidney and pancreas tx
and an isolated pancreas tx - ANSWER Combined: 4-8 hours
Isolated: 3-4 hours
What is the average length of stay - ANSWER 7-14 days
Pancreas anti- rejection medications - ANSWER depends on the transplant center, most
have triple therapy agents
Tacrolimus (Prograf) - ANSWER Calcineurin inhibitor: Calcineurin is an enzyme that activates T-
cells of the immune system
, Mycophenolate mofetil (cellcept) or mycophenolic acid (Myfortic) - ANSWER An anti-
proliferative agent: inhibit cell-cycle pathways to limit T- and B-cell proliferation and thereby
reducing the cytotoxic response directed toward the cardiac allograft.
Methylprednisolone (Solu medrol) - ANSWER Corticosteroid: lowers immune response
Sirolimus (Rapamycin/Rapamune) - ANSWER Can be used for some patients in lieu of a
calcineurin inhibitor to minimize the nephrotoxic effects associated with calcineurin inhibitors
What two meds will the patients be on long term and which ones will taper off? - ANSWER
Prograf/ Cellcept
patients will taper off prednisone
To avoid the effects of steriods what other medications can we use to avoid incrasesing
blood glucose levels - ANSWER Basilizimab (Simulect) monocolonal antibody
Alemtuzumab (Campath) moncolonal antibody
Antilymphocyte globulin ( Thymo) Polyclonal antibody
What cares should be expected..... - ANSWER OUT OF BED postop day 1
incision care: staples and sutures will remain for approx 3 weeks after surgery
psychosocial needs
education!
What are some of the Post transplant assessment and monitoring - ANSWER Cardiovascular
status
fluid and electrolyte balance
metabolic function
pancreatic graft function
Vitals
