CCTC UPDATED 2026 EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔Reason why native pancreas left in place during pancreas tx - ✔✔Allows the
exocrine function of native pancreas to be preserved.
✔✔Enteric Drainage( ED) post pancreas transplant - ✔✔More common, difficult to
detect rejection, donor portal vein anastomosed to recipients SMV(superior mesenteric
vein), donor duodenal segment attached to recipients jejunum, pancreases produces 2L
of fluid drainage, pancreatic enzymes excreted thru the stool
✔✔Advantages of Enteric drain (ED) post pancreas transplant - ✔✔More physiologic,
fewer metabolic imbalances because pancreatic secretions are reabsorbed, less post-
op complications
✔✔Bladder Drainage (BD) post pancreas transplant - ✔✔Easier to monitor for rejection
with urine amylase, may cause dehydration and cystitis. Direct monitoring of graft
exocrine function, easier to perform biopsy, less invasive if complications arise.
✔✔Disadvantages of Bladder Drainage (BD) post pancreas transplant -
✔✔Dehydration, cystitis, UTIs, metabolic acidosis, urine leak, hematuria, 35% go on to
need enteric conversion, pancreatitis
✔✔Patients with anastomotic leak post pancreas transplant may present with what? -
✔✔Elevated serum amylase levels
✔✔C-peptide normal range - ✔✔0.8-3.1
✔✔What is a sign of late rejection post pancreas transplant? - ✔✔Hyperglycemia
✔✔Patients with chronic pancreas rejection can present with what? - ✔✔Progressive
need for insulin
✔✔In pancreas transplant recipients temperature elevations may indicate what? -
✔✔Infection, pancreatitis, acute rejection
✔✔Cvp range post pancreas transplant - ✔✔5-10
✔✔When should you notify transplant team in regards to urine output s/p pancreas
transplant - ✔✔Urine output <50 and >200 ml/hr in the first 24hrs post tx
✔✔Why is it important for adequate perfusion of graft post pancreas tx - ✔✔Pancreas
graft is "low blood flow" organ higher potential for graft thrombosis
,✔✔Which rejection is more common in PTA patients? - ✔✔Acute happens earlier and
more frequent
✔✔Pancreatic graft function monitored by which labs? - ✔✔Serum glucose, serum
amylase and serum lipase concentrations, glycosylated hgb, fasting C-peptide
✔✔What can an acute spike in glucose level early postop pancreas tx indicate? -
✔✔Vascular thrombosis of graft, (US COMMONLY ORDERED TO RULE OUT
THROMBOSIS)
✔✔Serum amylase may be elevated 48-96hrs post pancreas tx due to what? -
✔✔Damage to the organ during cold ischemic preservation, manipulation of the organ
during recovery,
✔✔What can cause elevated serum amylase after pancreas tx - ✔✔Anastomoses leak,
venous thrombosis, subsequent to transplant biopsy
✔✔Decreased amylase in BD drain pancreas recipient can be caused by what? -
✔✔Indicative of graft rejection
✔✔What is a way to monitor for organ rejection in BD pancreas transplant recipients -
✔✔An 8 hour urine collection
✔✔Amylase levels 1500- 7000 IU/hr within a few days after pancreas transplant
indicate what? - ✔✔Good initial graft function
✔✔Clinical indications of vascular thrombosis in pancreas transplant recipients -
✔✔Abrupt rise in glucose, sharp rise in serum amylase or lipase, tenderness or pain
over graft site in BD recipients: massive hematuria, decrease or absence of urine
amylase levels,
✔✔Pancreatitis symptoms - ✔✔Low grade temp, elevated serum amylase and lipase(
these may be elevated first 2-3 days after tx) decreased urine amylase, graft
tenderness, abdominal pain, n&v, endocrine secretory capacity ( insulin secretion) often
only mildly impaired
✔✔ED pancreas tx anastomotic leak patients present with - ✔✔Fever, elevated WBC ,
n& v, abdominal pain, elevated serum amylase abd creatinine
✔✔How is pancreas rejection diagnosed (procedure) - ✔✔Pancreas allograft biopsy
, ✔✔Diagnoses leading to end stage lung disease in children - ✔✔Alveolar proteinosis,
bronchiectasis, bronchopulmonary dysplasia, cystic fibrosis, interstitial lung disease,
pulmonary hypertension
✔✔End stage heart disease diagnoses in children - ✔✔Congenital heart disease such
as hypoplastic left heart syndrome, cardiomyopathies, cardiac tumors
✔✔Kidney placement in infants and small children - ✔✔Kidney placed intraperitoneally,
donor vessels anastomosed directly to aorta and IVC, following reperfusion donor ureter
is anastomosed to the bladder
✔✔KDPI - ✔✔Score can help predict how a particular donor kidney is expected to
perform
✔✔Kidney placement > 3 years old - ✔✔Donor kidney implanted in an extra peritoneal
position, donor vessels anastomosed to iliac vessels
✔✔Calculation of child's BSA - ✔✔Hgt x wgt/3600
✔✔END STAGE LIVER DISEASE DIAGNOSES IN CHILDREN - ✔✔Biliary Atresia,
Alpha 1 Antitrypsin deficiency, Wilson's disease, alagilles syndrome, acute liver failure,
viral hepatitis, glycogen storage disease, liver tumor(hepatoblastoma)
✔✔end-stage renal disease (ESRD) diagnoses in children - ✔✔Renal
dysplasia/hypoplasia/aplasia, obstructive uropathy, focal segmental
glomerulosclerosis(FSGS), reflux pyelonephritis, henoch-schonlein purpura, bilateral
wilm's tumor
*younger child congenital more common, older child FSGS more common*
✔✔Tacrolimus (Prograf) - ✔✔Do not take before lab draw, taken bid, side effects
include HTN, dyslipidemia, headache, diarrhea, nausea, tremor, hair loss (alopecia),
hyperglycemia, changes in kidney function(nephrotoxic), adrenal insufficiency, DM
*tac toxicity-tremors, especially in hands, leukoencephalopathy- mental status changes
stop dc n
Med
✔✔Autotransplant - ✔✔Donation to self
✔✔Syngeneic transplant - ✔✔Transplant from identical twin
✔✔Allotransplant - ✔✔Transplant from another person
✔✔Xenotransplant - ✔✔Transplant from another species
SOLUTIONS RATED A+
✔✔Reason why native pancreas left in place during pancreas tx - ✔✔Allows the
exocrine function of native pancreas to be preserved.
✔✔Enteric Drainage( ED) post pancreas transplant - ✔✔More common, difficult to
detect rejection, donor portal vein anastomosed to recipients SMV(superior mesenteric
vein), donor duodenal segment attached to recipients jejunum, pancreases produces 2L
of fluid drainage, pancreatic enzymes excreted thru the stool
✔✔Advantages of Enteric drain (ED) post pancreas transplant - ✔✔More physiologic,
fewer metabolic imbalances because pancreatic secretions are reabsorbed, less post-
op complications
✔✔Bladder Drainage (BD) post pancreas transplant - ✔✔Easier to monitor for rejection
with urine amylase, may cause dehydration and cystitis. Direct monitoring of graft
exocrine function, easier to perform biopsy, less invasive if complications arise.
✔✔Disadvantages of Bladder Drainage (BD) post pancreas transplant -
✔✔Dehydration, cystitis, UTIs, metabolic acidosis, urine leak, hematuria, 35% go on to
need enteric conversion, pancreatitis
✔✔Patients with anastomotic leak post pancreas transplant may present with what? -
✔✔Elevated serum amylase levels
✔✔C-peptide normal range - ✔✔0.8-3.1
✔✔What is a sign of late rejection post pancreas transplant? - ✔✔Hyperglycemia
✔✔Patients with chronic pancreas rejection can present with what? - ✔✔Progressive
need for insulin
✔✔In pancreas transplant recipients temperature elevations may indicate what? -
✔✔Infection, pancreatitis, acute rejection
✔✔Cvp range post pancreas transplant - ✔✔5-10
✔✔When should you notify transplant team in regards to urine output s/p pancreas
transplant - ✔✔Urine output <50 and >200 ml/hr in the first 24hrs post tx
✔✔Why is it important for adequate perfusion of graft post pancreas tx - ✔✔Pancreas
graft is "low blood flow" organ higher potential for graft thrombosis
,✔✔Which rejection is more common in PTA patients? - ✔✔Acute happens earlier and
more frequent
✔✔Pancreatic graft function monitored by which labs? - ✔✔Serum glucose, serum
amylase and serum lipase concentrations, glycosylated hgb, fasting C-peptide
✔✔What can an acute spike in glucose level early postop pancreas tx indicate? -
✔✔Vascular thrombosis of graft, (US COMMONLY ORDERED TO RULE OUT
THROMBOSIS)
✔✔Serum amylase may be elevated 48-96hrs post pancreas tx due to what? -
✔✔Damage to the organ during cold ischemic preservation, manipulation of the organ
during recovery,
✔✔What can cause elevated serum amylase after pancreas tx - ✔✔Anastomoses leak,
venous thrombosis, subsequent to transplant biopsy
✔✔Decreased amylase in BD drain pancreas recipient can be caused by what? -
✔✔Indicative of graft rejection
✔✔What is a way to monitor for organ rejection in BD pancreas transplant recipients -
✔✔An 8 hour urine collection
✔✔Amylase levels 1500- 7000 IU/hr within a few days after pancreas transplant
indicate what? - ✔✔Good initial graft function
✔✔Clinical indications of vascular thrombosis in pancreas transplant recipients -
✔✔Abrupt rise in glucose, sharp rise in serum amylase or lipase, tenderness or pain
over graft site in BD recipients: massive hematuria, decrease or absence of urine
amylase levels,
✔✔Pancreatitis symptoms - ✔✔Low grade temp, elevated serum amylase and lipase(
these may be elevated first 2-3 days after tx) decreased urine amylase, graft
tenderness, abdominal pain, n&v, endocrine secretory capacity ( insulin secretion) often
only mildly impaired
✔✔ED pancreas tx anastomotic leak patients present with - ✔✔Fever, elevated WBC ,
n& v, abdominal pain, elevated serum amylase abd creatinine
✔✔How is pancreas rejection diagnosed (procedure) - ✔✔Pancreas allograft biopsy
, ✔✔Diagnoses leading to end stage lung disease in children - ✔✔Alveolar proteinosis,
bronchiectasis, bronchopulmonary dysplasia, cystic fibrosis, interstitial lung disease,
pulmonary hypertension
✔✔End stage heart disease diagnoses in children - ✔✔Congenital heart disease such
as hypoplastic left heart syndrome, cardiomyopathies, cardiac tumors
✔✔Kidney placement in infants and small children - ✔✔Kidney placed intraperitoneally,
donor vessels anastomosed directly to aorta and IVC, following reperfusion donor ureter
is anastomosed to the bladder
✔✔KDPI - ✔✔Score can help predict how a particular donor kidney is expected to
perform
✔✔Kidney placement > 3 years old - ✔✔Donor kidney implanted in an extra peritoneal
position, donor vessels anastomosed to iliac vessels
✔✔Calculation of child's BSA - ✔✔Hgt x wgt/3600
✔✔END STAGE LIVER DISEASE DIAGNOSES IN CHILDREN - ✔✔Biliary Atresia,
Alpha 1 Antitrypsin deficiency, Wilson's disease, alagilles syndrome, acute liver failure,
viral hepatitis, glycogen storage disease, liver tumor(hepatoblastoma)
✔✔end-stage renal disease (ESRD) diagnoses in children - ✔✔Renal
dysplasia/hypoplasia/aplasia, obstructive uropathy, focal segmental
glomerulosclerosis(FSGS), reflux pyelonephritis, henoch-schonlein purpura, bilateral
wilm's tumor
*younger child congenital more common, older child FSGS more common*
✔✔Tacrolimus (Prograf) - ✔✔Do not take before lab draw, taken bid, side effects
include HTN, dyslipidemia, headache, diarrhea, nausea, tremor, hair loss (alopecia),
hyperglycemia, changes in kidney function(nephrotoxic), adrenal insufficiency, DM
*tac toxicity-tremors, especially in hands, leukoencephalopathy- mental status changes
stop dc n
Med
✔✔Autotransplant - ✔✔Donation to self
✔✔Syngeneic transplant - ✔✔Transplant from identical twin
✔✔Allotransplant - ✔✔Transplant from another person
✔✔Xenotransplant - ✔✔Transplant from another species
