Transplant Questions

Exam questions

1. Which of the following maternal-fetal complication is not generally associated with pregnancy after organ transplantation?

a. hypertension
b. prematurity,
c. macrasomia
d. low birth weight.

Rational: hypertension, prematurity and low birth weight is each a known complication of post transplant pregnancy. Macrasomia is often associated with diabetes mellitus and gestational diabetes, low birth weight is more likely to occur in the post transplant setting.

2. Organ transplant may result in a change in which sperm characteristic?

a. sperm ph
b. sperm counts
c. sperm morphology
d. sperm motility

Rational Transplantation restores the balance in the hypothalamic-pituitary axis is associated with improvements in sperm motility but not in sperm counts or morphology, there is no effect on sperm ph.

3. Chances of successful pregnancy are increased all of the following except…

a. hematocrit levels > 42%
b. immunosuppressive medications at maintenance levels,
c. serum creatinine levels less than 1.3 mg/dL
d. absence of graft rejection for at least a year,

Rational: absence of graft rejection, stable immunosuppression and serum creatinine <1.3mg/dl all increase chances of successful pregnancy. A hematocrit of 42%t is s normal and supportive of pregnancy but not specifically cited as contributing to post transplant success.

4. Barrier methods of contraception are the method of choice for post transplant patents.

a. True
b. False

Rational: Due to high levels of immunosuppressive therapy, pregnancy in the immediate post implantation period can lead to unacceptable fetal risks and/or anomalies. The potential for barrier failure to too high to rely upon barrier contraception alone.

5. In counseling post transplantation patients about the importance of contraception the clinician should explain that…

a. Contraception is unnecessary because it takes a year for fertility to return
b. The post implantation period involves use of potentially fetotoxic or teratogenic medications which present a risk to the developing embryo so it is important to avoid unintended pregnancy
c. Oral Contraceptives have the potential to interfere with immunosuppressive therapy and should be avoided.
d. IUDs are the female contraceptive of choice

Rational: Fertility can return as early as one month post transplant. Oral contraceptives have not been generally shown to interfere with immunosuppression, and IUDs carry a higher risk for infection due to immunotherapy. A significant risk is posed by fetotoxic and teratogenic immunosuppressive drugs.