Transplantation and Surgical Oncology
Transplantation and Surgical Oncology tests donor and recipient selection, immunosuppression, rejection, and oncologic principles including multidisciplinary care. The exam links immunology to clinical outcomes.
Transplant
- Kidney: evaluate HLA matching and crossmatch; hyperacute rejection is antibody-mediated and occurs minutes to hours; treat with graft removal.
- Liver: MELD score allocates; biliary complications and rejection are common; maintain immunosuppression.
- Pancreas: often simultaneous pancreas-kidney for type 1 diabetes with renal failure.
Oncology
- Principles: complete resection with negative margins (R0), adequate lymphadenectomy, stage-directed multimodal therapy. Neoadjuvant therapy for locally advanced rectal cancer, esophageal cancer, and some breast cancers.
- Multidisciplinary tumor board: surgery, medical oncology, radiation, pathology, radiology.
Worked example: A 55-year-old has sigmoid colon cancer and two liver metastases. Reasoning: stage with CT and PET; a multidisciplinary plan may include colectomy plus liver resection or neoadjuvant chemotherapy, depending on resectability and biology; do not resect without staging.
Traps: transplanting a kidney across a positive crossmatch; stopping immunosuppression abruptly; assuming all liver lesions are metastases; resecting rectal cancer without considering neoadjuvant therapy.