Solid Organ Transplantation: The Evaluation Process

Comprehensive vocabulary flashcards covering the pretransplant evaluation process for solid organ transplantation, including infectious disease screening, oncology screening, psychosocial/financial assessments, organ-specific tests, and cardiac transplant evaluations.

Herpes Simplex Virus Type 1 (HSV1)

An Alphaherpesvirinae acquired in childhood or young adulthood that can reactivate under immunosuppression; status is established by testing recipient blood for IgG antibodies.

Toxoplasma gondii

A coccidian parasite of the cat population for which humans are intermediate hosts; evaluated via recipient IgG antibody testing due to the high risk of life-threatening infection in mismatched or immunocompromised recipients.

Purified Protein Derivative (PPD)

An intradermal skin test commonly performed on all transplant candidates to screen for tuberculosis exposure.

Anergy Panel

Control skin tests using common antigens (Candida and mumps) applied alongside the PPD to verify whether an extremely ill patient is capable of mounting an immune response.

Pretransplant Cancer Screening Guidelines

Age- and gender-appropriate protocols outlined by the American Cancer Society, including cervical cancer screening for women older than 21 (younger if sexually active), mammography for women older than 40, colonoscopy for adults older than 50, and PSA with digital rectal examination for men older than 50.

Bone Densitometry

A diagnostic screening used to assess osteopenia or osteoporosis in postmenopausal candidates, as well as those with a history of smoking, chronic corticosteroid use, or cholestatic liver disease.

Psychosocial Evaluation

A pretransplant assessment conducted by a social worker with psychologist or psychiatrist input to evaluate transplant appropriateness, informed consent capability, adherence history, regimen compliance ability, and social support structure.

Centers for Medicare and Medicaid Services (CMS) Approval

The federal designation required for transplant programs in the United States to receive Medicare funding for elderly and disabled organ recipients.

Nutritional Evaluation

An assessment conducted by a registered dietitian to identify surgical contraindications such as severe obesity, manage cachexia with enteral or parenteral support, and educate candidates on risks like posttransplant diabetes mellitus and hyperlipidemia.

Pharmacologic Cardiac Stress Testing

Myocardial perfusion imaging performed using adenosine, dipyridamole, or dobutamine in candidates with end-stage organ disease who are unable to walk on a treadmill.

Urine Cotinine Testing

A random laboratory assay utilized by transplant centers to verify smoking cessation prior to placing a candidate on the waiting list.

Pretransplant Vascular Evaluation

Diagnostic testing consisting of Doppler imaging and ankle-brachial index testing of bilateral lower extremities and bilateral carotid arteries in patients with diabetes, coronary artery disease, claudication, or cerebrovascular accident.

Nonischemic Cardiomyopathy

A disease category encompassing dilated, restrictive, and hypertrophic cardiomyopathies that accounts for the primary indication in $54\%$ of heart transplant recipients.

Right Heart Catheterization (Pre-Heart Transplant)

A hemodynamic study used to measure right ventricular function and degree of pulmonary hypertension, identifying severe fixed pulmonary hypertension (pulmonary vascular resistance $> 5\,\text{Wood units}$ or transpulmonary gradient $> 20$) which is a contraindication to heart transplantation.

Vasodilator Challenge

The administration of agents such as oxygen, nitric oxide, nitroglycerin, milrinone (Primacor), nesiritide (Natrecor), or prostaglandin (Flolan) during right heart catheterization to test the reversibility of pulmonary hypertension.

Cardiopulmonary Exercise Testing (CPET)

A test measuring ventilatory gas exchange during incremental treadmill or bicycle ergometer exercise that provides the most reliable determination of functional aerobic capacity in heart failure candidates.

Myocardial Viability Testing

Cardiac magnetic resonance imaging (MRI) or positron emission tomography (PET) scanning performed in candidates considered for revascularization or ventricular aneurysmectomy to determine viable tissue.