Transplant NEET Questions 36-40

NEET   Transplant Questions  from Surgery Exam

Questions 31-35 (Chest)

Questions 36-40

Questions 41-45

Questions 46-50

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Q 36 Now a days contraindication for liver transplant is

a) HIV positive status of the recipient

b) Active infection with SIRS

c) Complete portal vein thrombosis 

d) HCC with 3 lesions , one is segment II and other two in segment IV, maximum size is 2.8 cm

36) b

Liver transplantation is an ever changing branch. Diseases which were contraindications in early 2000 are no longer contraindicated with advances in surgery, critical care and anesthesia

HIV is no longer a contraindication because of effective antiviral drugs, life expectancy has improved. Similarly portal vein thrombosis patients are also done and jump grafts can be taken from proximal SMV

According to Milan criteria, HCC with 3 lesions, maximum less than 3cm is not a contraindication

Active infection with sepsis and SIRS is still a contraindication.


Q37 ) Living donor liver transplant (LDLT) is done in centers where cadaveric donations are few. Which of the following is true about it?

a) Only right lobe of the donor can be used

b) Only left lobe can be used

c) In LDLT bile leak is more than cadaveric donor

d) Small for size liver is defined as liver size less than 0.5% of recipient BSA

37 c

In LDLT both lobes can be taken. Generally the rule is that, 30% remnant should stay with the donor and Graft recipient weight ratio (GRWR) should be more than .8 although it can be as low as .6%.

GRWR does not take BSA into account

Both right and left lobes are used.

Bile leak rate is more in LDLT than DDLT because of small size of the donor duct.

 

 


Q38) The significance of MELD Scoring in Liver transplant is :

a) Less ill patients are given more priority in liver transplant

b) Set threshold for patients who are too ill to undergo transplant.

c) To access  mortality in the waiting list.

d) To list patients in cadaveric deceased donor program

38 d

MELD score takes into account  three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. 
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).

In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.

Sicker patients are given priority


Q39) Most common viral  infection in transplant patients on immunosuppression

a) CMV

b) HSV

c) HIV

d) HPV

39) a

CMV

CMV infection is the commonest and presents in 4-8 weeks after transplant with fever, leukopenia and lethargy

It can occur as pneumonia, diarrhea, hepatitis, retinitis and encephalitis

Treatment is valgancyclovir

HSV presents with mucocutaneous lesions near mouth and genitalia.


Q40) True about liver transplant

a) Portal vein thrombosis is more common than Hepatic Artery thrombosis

b) Bile leak though common is not a significant problem

c) Any bleeding in post op period, patient should be taken to OT

d) Acute liver rejection is seen in 5-10% cases

40. b

Acute rejection is seen in 20-30% cases but most resolve with steroid pulse therapy.

Hepatic artery thrombosis is more common than portal vein thrombosis.

Not all bleeding need to be re explored. Most of them improve with correction of coagulopathy. Bile leak is mostly

from the cut surface in LDLT and resolve gradually.

 

 

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