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Transplantation surgery

Major Clinical Specialty Areas · 20 questions · 1 free to try

Kidney, liver and pancreas transplantation from listing to the early post-operative period: allocation, recipient assessment, organ retrieval and preservation, machine perfusion, vascular and biliary complications, rejection treatment, infection prophylaxis and living donation.

Every question in this topic is a single best answer item in the style of the exam, followed by an explanation that gives the reasoning for the correct option, why each distractor is wrong, a key point to carry into the exam and, where one applies, the guideline or trial it rests on. Practice mode lets you work through the topic on its own or mixed with others; exam mode draws it into timed papers.

Sample question from this topic

You are the recipient surgeon on call. A DBD donor offer is received for your 54-year-old recipient with hepatocellular carcinoma within transplant criteria. The donor is a 47-year-old with catastrophic intracranial haemorrhage, stable on low-dose noradrenaline, with normal liver biochemistry and a 20-minute period of CPR three days ago. Past history reveals a cutaneous melanoma excised three years ago, reported as Breslow 1.8 mm with a positive sentinel node treated by completion dissection. What is the most appropriate response to this liver offer?

  1. AAccept — the melanoma was treated with curative intent more than two years ago
  2. BAccept, but only after a donor PET-CT excludes recurrence
  3. CDecline the offer because of unacceptable risk of tumour transmission
  4. DAccept with a plan for prophylactic immunotherapy in the recipient
  5. EDecline because of the period of CPR
Show answer and explanation

Correct answer: C

Melanoma is among the most feared donor-transmitted malignancies: it metastasises early, can recur after long disease-free intervals, and transmitted disease in an immunosuppressed recipient is usually fatal. A node-positive melanoma three years earlier represents an unacceptable transmission risk, and the correct answer is to decline. UK guidance (SaBTO) treats melanoma as an absolute or near-absolute contraindication to donation regardless of apparent cure.

Why the others are wrong: A — disease-free interval does not neutralise melanoma risk; late recurrence a decade or more after excision is well described. B — a normal PET-CT cannot exclude micrometastatic disease and does not change the risk category. D — there is no accepted prophylactic regimen that makes a high-risk donor malignancy transferable. E — a witnessed arrest with 20 minutes of CPR and subsequently normal liver biochemistry is not a contraindication; many such donors yield excellent grafts.

Key point: assess donor malignancy by tumour biology, not by time elapsed — melanoma, choriocarcinoma and most metastatic cancers are contraindications, whereas low-grade CNS tumours and many treated low-risk cancers are not.

Guidelines: SaBTO advice on organs from donors with malignancy; NHSBT deceased donor offering policies on transmissible cancer risk.

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