Transplant

Pancreas transplant

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Q) Most common indication for pancreas transplant

a) Type II DM 

b) Type II DM with nephropathy

c) Type I DM

d) Type I DM with nephropathy

d) Type I DM with nephropathy

Pancreas transplantation is typically performed for individuals with Type 1 diabetes who also have end-stage renal disease, often requiring kidney dialysis. This combination of kidney failure and Type 1 diabetes makes pancreas transplantation a viable treatment option.

SPK is the most frequently performed procedure for patients with type 1 diabetes and renal failure due to diabetic nephropathy.

There is a small population of patients with type 1 diabetes with renal failure due to primary renal disease or non-diabetic causes and they are also included in this group.

 

Anti rejection drugs

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Q) Anti Rejection medicine which also prevents tumor recurrence? MCH Questions ...

a) M tor inhibitors

b) IL2 blockers

c) Steroids

d) Azathioprine

Ans a) mtor inhibitors 

One Question is always asked about anti rejection medicines, Salient points i am enumerating

  1. Three drug regimen is classic includes IL2 blocker, Mycophenolate and steroids which are tapered . IL 2 blocker  Tacrolimus is used more than Cyclosporine ( cyclosporine less used now). IL2 blocker side effects are hirsutism, hyperkalemia, gum hypertrophy etc) 
  2. Mycophenolate is preferred over azathioprine . Both cause fall in cell lines
  3. Steroids have many side effects like weight gain, cataract, infections and are used in tapering dose

M-tor inhibitors are sirolimus and Everolimus which are used when transplant is done for HCC, IT has anti tumor action.

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Immunosuppression

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Q) False regarding immunosuppresant medicines ?

a. MMF is a reversible inhibitor of IMD-DH
b. Both Cyclosporine  and tacrolimus inhibit NF-KB and its downstream effects
c. Everolimus acts on FKBP12To inhibit Calcineurin activity
d. ALG are more used in pancreas transplant

Ciclosporins

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Q) Not true about ciclosporin use in liver transplant

a) It exerts its effect the same way as tacrolimus

b) Nephrotoxicity is the main notable side effect

c) Both tacrlimus and ciclosporin have equal rates of preventing acute rejection

d) Hypetrension, DM and dyslipidemia are other common side effects

 

Allograft Rejection

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Q) Which of the following is false regarding HLA in graft rejection? 

a) HLA (Human leucocyte antigen) is the most common cause of graft rejection

b) They mainly serve as antigen recognition unit

c) HLA also serve as effector cells 

d) They are highly polymorphic

Pediatric liver transplant

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Pediatric Liver Transplant MCQ – Most Common Indication

📘 Theme: Hepatobiliary Surgery / Liver Transplantation (DNB SS / NEET SS High Yield)

Clinical Liver Transplant MCQ

Which of the following is the most common indication for pediatric liver transplantation?

A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
D. HCV

Answer: A. Biliary atresia

Explanation

Biliary atresia is the most common indication for liver transplantation in children. It presents with persistent jaundice after birth due to progressive obliteration of the extrahepatic biliary tree. The exact etiology remains unclear.

Typical findings include absent or fibrotic extrahepatic bile ducts and a small or absent gallbladder. Liver biopsy is diagnostic and demonstrates bile duct proliferation, portal fibrosis, and cholestasis.

Why other options are incorrect

  • Metabolic diseases: Important indications for pediatric liver transplantation but less common than biliary atresia.
  • Alagille syndrome: A rare genetic disorder causing chronic cholestasis and may require transplantation in selected patients.
  • HCV: An uncommon indication for pediatric liver transplantation.

High-yield teaching points

  • Biliary atresia is the commonest indication for pediatric liver transplantation.
  • Usually presents with persistent neonatal jaundice, pale stools, and dark urine.
  • Kasai portoenterostomy is the initial surgical treatment.
  • Many patients eventually progress to cirrhosis and require liver transplantation.
  • Early diagnosis improves outcomes.

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Post transplant malignancy

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 Q ) Most common malignancy in post-transplant individuals
A. PTLD
B. Skin- Squamous cell carcinoma
C. Kaposi sarcoma
D. CNS Lymphoma

Primary Graft non function

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Q) Causes of primary graft non function are A/E

a) Recipient with renal failure

b) Microsteatosis > 60%

c) Cold ischaemia time > 12hrs

d) Non heart beating donor

Premium answer

Discuss the causes of PNF-Primary non function of liver