ABIM Transplant Hepatology Initial Certification Examination Practice Test
Transplant hepatology applies liver-disease expertise to evaluation before transplantation and care after graft placement. The available practice questions touch on cirrhosis complications, donor-derived infection risk, graft vascular problems, immunosuppressant interactions, and prevention of recurrent viral hepatitis. These subjects require linking clinical findings and laboratory changes to the timing of transplantation and the patient’s underlying liver disease.
Exam overview
About the ABIM Transplant Hepatology Initial Certification Examination Exam
The cases exercise decisions across the transplant course: recognizing hepatic encephalopathy recurrence, interpreting donor hepatitis C antibody and RNA results, and responding to early postoperative cholestasis with absent hepatic arterial flow. They also address medication management, including how rifampin can alter tacrolimus exposure and which toxicity to monitor when considering everolimus in a patient with kidney disease. Post-transplant infectious disease reasoning includes Pneumocystis pneumonia treatment, while prevention questions involve hepatitis B recurrence and travel-related vaccine safety for immunosuppressed recipients. Other scenarios call for surveillance planning for hepatocellular carcinoma in a cirrhotic graft and evaluation of sustained creatinine elevation with proteinuria and metabolic comorbidities. Together, these tasks emphasize integrating graft status, immunosuppression, infection risk, and extrahepatic disease when choosing an evaluation or management approach.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A patient with cirrhosis has had two episodes of overt hepatic encephalopathy and is taking lactulose. Which additional medication is commonly added to reduce recurrence?
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Correct answer: ARifaximin is commonly added to lactulose for prevention of recurrent overt hepatic encephalopathy. It reduces intestinal ammonia-producing bacterial activity and is not a substitute for evaluating and treating precipitating factors such as infection, bleeding, or constipation.
A liver transplant recipient taking tacrolimus has a trough concentration below the individualized target after starting rifampin for a separate infection. Which explanation best accounts for this change?
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Correct answer: ARifampin is a potent inducer of CYP3A enzymes and transporters such as P-glycoprotein, which can substantially reduce tacrolimus concentrations and risk under-immunosuppression. The interaction should prompt coordinated medication review and close therapeutic drug monitoring.
A recipient of a liver from a donor with positive hepatitis C antibody but undetectable HCV RNA has no other donor risk information. Which statement is most accurate?
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Correct answer: BHCV antibody can reflect past infection or, less commonly, a false-positive result; undetectable HCV RNA means viremia was not detected in the tested sample. Donor assessment and recipient monitoring should follow current protocols, and antibody status alone does not establish active infection.
A liver transplant recipient develops fever and hypoxemia about 2 months after transplantation. Chest imaging shows diffuse bilateral ground-glass opacities, and bronchoalveolar lavage testing detects Pneumocystis jirovecii. Which treatment is preferred for this infection?
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Correct answer: APneumocystis pneumonia in a solid-organ transplant recipient is treated first-line with trimethoprim-sulfamethoxazole, with dose adjustment as needed for renal function and clinical severity. Transplant recipients commonly receive prophylaxis against this infection during periods of heightened immunosuppression.
A liver transplant recipient with cirrhosis in the graft is undergoing routine surveillance for hepatocellular carcinoma. Which surveillance approach is generally used?
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Correct answer: AFor patients with cirrhosis who are candidates for treatment if cancer is found, surveillance is generally performed with liver ultrasound about every 6 months. AFP may be used as an adjunct in some practices, and alternative imaging may be appropriate when ultrasound visualization is inadequate.
A liver transplant recipient has a newly detected, sustained increase in serum creatinine. Urinalysis shows proteinuria, and the patient has diabetes and hypertension. Which evaluation principle is most appropriate?
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Correct answer: APost-transplant kidney dysfunction is often multifactorial. Evaluation should include medication exposure, hemodynamic and volume factors, metabolic disease, urinalysis and proteinuria assessment, and consideration of intrinsic renal disease. Immunosuppression changes should be made in coordination with the transplant team rather than on assumption alone.
A liver transplant recipient develops fever, right upper-quadrant discomfort, and cholestatic liver test abnormalities 3 weeks after surgery. Doppler ultrasound shows absent flow in the hepatic artery. Which complication is most likely?
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Correct answer: AThe hepatic artery is the primary blood supply to the bile ducts. Early hepatic artery thrombosis can cause biliary ischemia, cholestatic abnormalities, and serious graft complications; Doppler evidence of absent arterial flow is strongly concerning.
How to use this practice test
Access the 50-question practice bank free; each session presents up to 20 questions selected at random. Use a session to test clinical reasoning across transplant-related scenarios, then review the results to identify topics where you need to revisit mechanisms, diagnostic interpretation, or management decisions.
Preparation tips
- For encephalopathy scenarios, distinguish acute episode management from strategies intended to reduce recurrence, including the role of lactulose and add-on therapy.
- Review how CYP3A-inducing drugs such as rifampin affect tacrolimus exposure, and connect trough changes to interaction assessment and dose monitoring.
- Practice interpreting donor HCV antibody and RNA results separately, and review how donor virology informs recipient risk assessment.
- Compare early hepatic artery thrombosis with other causes of postoperative cholestasis using timing, Doppler findings, and graft presentation.
- Review infection prevention and treatment in immunosuppressed recipients, including Pneumocystis treatment, hepatitis B recurrence prevention, and live-vaccine safety.