Chapter 20 Transplant

Question 1

The most common reason for liver transplant in US

Answer 1

Cirrhosis, due to chronic hep C and alcohol abuse

Question 2

Scoring system for assessing the severity of chronic liver disease

Answer 2

MELD— Model for End-stage Liver Disease

Question 3

Cadaveric liver donation connections:

Answer 3

-pretty much the same connections as the native liver

Question 4

Living donor donation usually donates the ___ lobe

Answer 4

Right

Question 5

The _________ are not routinely included in the native liver exam, but they are very important to image in transplanted patient

Answer 5

Hepatic arteries

Question 6

A low RI can indicate

Answer 6

Proximal stenosis

Question 7

High RI can indicate:

Answer 7

Rejection or hepatic venous congestion

Question 8

Hepatic artery flow through out diastole: _____ resistance

Answer 8

Low resistance

Question 9

Hepatic arteries velocities should be below:

Answer 9

200 cm/s

Question 10

A normal RI in the hepatic artery is:

Answer 10

.5-.7

Question 11

The most common cause for liver transplant failure is _____

Answer 11

Rejection

Question 12

Acute rejection occurs within the first _____

Answer 12

10 days

Question 13

Thrombosis and stenosis most commonly occurs at the ____ sites

Answer 13

Anastomosis sites

Question 14

Hepatic vein/IVC thrombosis and stenosis color Doppler will show:

Answer 14

Aliasing, turbulence, tripling of the spectral Doppler waveform

Question 15

Hepatic artery stenosis: ______ waveform

Answer 15

Tardus parvus

Question 16

Hepatic artery stenosis velocity:

Answer 16

Greater than 200 cm/s

Question 17

Hepatic artery stenosis RI:

Answer 17

Less than .5

Question 18

The most common vascular complication of liver transplantation is:

Answer 18

Hepatic artery(HA) thrombosis

Question 19

_____ is the only vascular supply to the bile ducts

Answer 19

Hepatic artery (HA)

Question 20

Biliary complications usually occur within the first ______ months after transplantation

Answer 20

3 months

Question 21

Most common biliary complication:

Answer 21

Obstruction

Question 22

Hematomas are most common along the ____ spaces near the vascular and biliary anastomoses sites

Answer 22

Perihepatic

Question 23

Recurrence of HCC is seen in about ___% of patients after their liver transplant

Answer 23

40%

Question 24

The most common site of HCC recurrence is:

Answer 24

Lung, and then the liver

Question 25

Portal venous gas is a common finding on ultrasound during the _____ period following transplantation

Answer 25

Early postoperative

Question 26

Post-Transplant Lymphoproliferative Disorder appears:

Answer 26

hypoechoic soft tissue mass and may encase hepatic hilum

Question 27

Transjugular Intrahepatic Portal-Systemic Shunt(TIPS) is placed:

Answer 27

Between right hepatic vein and right portal vein

Question 28

A widely patant TIPS, the RPV and LPV will demonstrate _____- flow

Answer 28

hepatofugal

Question 29

TIPS is placed by using ____ access

Answer 29

Jugular

Question 30

TIPS is placed to:

Answer 30

Lower portal pressure(portal HTN)

Question 31

TIPS malfunction: velocity

Answer 31

<50cm/s or >190cm/s

Question 32

TIPS malfunction: _____ flow of LPV or RPV

Answer 32

Hepatopetal

Question 33

The most common cause for needing a renal transplant is:

Answer 33

chronic end-stage renal disease or renal failure

Question 34

Most common cause of renal disease leading to kidney transplant

Answer 34

Diabetes

Question 35

Renal transplant is usually placed into the:

Answer 35

Right iliac fossa

Question 36

In cadaveric renal transplants, the donors MAIN RENAL ARTERY is harvested with a portion of the AORTA which is then anastomosed to:

Answer 36

The side of recipient external iliac artery

Question 37

Live donor transplants involve a direct anastomosis of _____ to the _______

Answer 37

Renal arterial graft to the external or internal iliac artery

Question 38

The main renal vein is almost always grafted to the recipient ______ in a ___ to side manner

Answer 38

External iliac vein in an end to side manner

Question 39

Renal: low RI indicates

Answer 39

Proximal stenosis

Question 40

Renal: high RI indicates

Answer 40

Rejection, renal venous congestion

Question 41

Normal renal transplant sonographic findings: ______ flow

Answer 41

Continuous diastolic flow

Question 42

Normal renal transplant sonographic findings: _____ resistance wave form

Answer 42

Low resistance

Question 43

Normal renal transplant sonographic findings: velocities should be:

Answer 43

Below 250cm/s

Question 44

Normal renal transplant sonographic findings: RI in the arcuate artery:

Answer 44

.6-.7

Question 45

Most common biopsy complication:

Answer 45

Bleeding

Question 46

Causes of draft dysfunction or failure(renal):

Answer 46

- rejection - acute tubular necrosis - pyelonephritis - drug nephrotoxicity

Question 47

Renal graft dysfunction/failure: pyelonephritis occurs in ___% of patients in the first year

Answer 47

80%

Question 48

The most common complications immediately postoperative and within the first year of transplantation are: _______ and ______

Answer 48

- Acute rejection | - Acute Tubular Necrosis

Question 49

Renal graft complications: arterial flow RI:

Answer 49

> .8

Question 50

In early stages following transplantation, the most common cause of hypertension is ______

Answer 50

Acute rejection

Question 51

Urinary obstruction & stones: The most common site of obstruction is—

Answer 51

At the site of ureteral implantation into the bladder

Question 52

(Renal) echogenic foci with shadowing or “twinkle” artifact on color Doppler:

Answer 52

Stones

Question 53

Early ultrasound findings of renal vein stenosis and thrombosis:

Answer 53

Renal enlargement, hypoechoic cortex(edema)

Question 54

Late ultrasound findings of renal vein stenosis and thrombosis:

Answer 54

-decreasing size and increased echogenicity

Question 55

Renal artery thrombosis or stenosis: peak systolic velocity:

Answer 55

Greater than or equal to 250cm/s

Question 56

Renal artery thrombosis or stenosis: velocity difference between pre and post stenotic segments ____

Answer 56

2:1

Question 57

Renal artery thrombosis or stenosis: _____ waveform distal to stenosis

Answer 57

Tardus parvus

Question 58

Renal artery thrombosis or stenosis: Renal artery/Aorta Ratio(RAR)

Answer 58

>3.5

Question 59

Most common peri-transplant fluid collection

Answer 59

Lymphoceles

Question 60

Lymphoceles are typically found ____ to the transplant

Answer 60

Medial

Question 61

Most common fluid collection that causes hydronephrosis

Answer 61

Lymphocele

Question 62

Most severe complication found in solid organ as well as stem cell transplantation:

Answer 62

Post-Transplant Lymphoproliferative Disorder(PTLD)