Pre-Transplant Evaluation and Care
What the exam tests
Pre-transplant questions focus on candidate selection, risk stratification, and the ethics of listing. Understand absolute versus relative contraindications, organ-specific workup (cardiac, pulmonary, renal, hepatic), psychosocial evaluation, HLA typing and crossmatching, panel-reactive antibody interpretation, and waitlist management.
Traps
- Active versus treated malignancy. Most centers require a disease-free interval; active or recently treated cancer is generally an absolute or strong relative contraindication. Questions test whether you distinguish "history of" from "active."
- Infection timing. Active untreated infection delays transplant; adequately treated infection usually does not permanently exclude.
- Substance use and adherence. Active substance use and documented nonadherence are relative contraindications assessed case by case-not automatic permanent exclusions.
- Crossmatch interpretation. A positive cytotoxic crossmatch generally precludes transplant because of preformed antibodies; virtual crossmatch uses antibody profiles instead of physical mixing.
- PRA/cPRA meaning. A high calculated PRA means harder to match, not that the patient is too sick to transplant.
Rule of thumb
Frame every pre-transplant question as benefit versus risk over the expected graft lifespan. A comorbidity that would shorten survival below expected graft life is the classic disqualifier.
Worked example
A 58-year-old with a myocardial infarction 3 months ago and an ejection fraction of 30% is being evaluated for kidney transplant. Active severe cardiac disease is a relative-to-absolute contraindication until optimized; the answer is cardiology optimization and reassessment, not immediate listing.