CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 2 — Questions and Answers
Question 1: When BK viremia is detected on surveillance in a kidney transplant recipient, the standard first intervention is:
- Adding antiviral therapy with ganciclovir
- Reducing immunosuppression, typically by decreasing mycophenolate dose (Correct answer)
- Initiating empiric antibiotics
- Performing an immediate kidney biopsy without any other change
Correct answer: Reducing immunosuppression, typically by decreasing mycophenolate dose
Reduction of immunosuppression — most commonly decreasing or stopping mycophenolate — is the primary treatment for BK viremia to allow the immune system to control viral replication.
Question 2: Which live vaccine is CONTRAINDICATED in immunocompromised solid organ transplant recipients?
- Inactivated influenza (IIV)
- Recombinant zoster vaccine (RZV/Shingrix)
- MMR (measles, mumps, rubella) (Correct answer)
- Pneumococcal polysaccharide vaccine (PPSV23)
Correct answer: MMR (measles, mumps, rubella)
MMR is a live attenuated vaccine and is absolutely contraindicated post-transplant due to the risk of vaccine-strain infection in immunocompromised hosts.
Question 3: Annual inactivated influenza vaccination is recommended for transplant recipients primarily because:
- It is required by UNOS policy
- Influenza infection can trigger acute rejection and cause severe disease in immunocompromised hosts (Correct answer)
- It prevents CMV reactivation
- It is mandated by Medicare conditions of participation
Correct answer: Influenza infection can trigger acute rejection and cause severe disease in immunocompromised hosts
Influenza can cause severe illness, pneumonia, and may trigger immune activation leading to acute rejection in transplant recipients, making annual vaccination critical.
Question 4: A liver transplant recipient who received a TB-positive donor organ (via IGRA) requires post-transplant treatment. The preferred regimen for latent TB infection (LTBI) treatment in this setting is:
- Immediate four-drug active TB therapy for 9 months
- Isoniazid (INH) for 9 months with vitamin B6 supplementation (Correct answer)
- No treatment needed if the recipient is IGRA-negative
- Rifampin for 4 months, preferred over isoniazid in transplant recipients
Correct answer: Isoniazid (INH) for 9 months with vitamin B6 supplementation
Isoniazid 9-month therapy with pyridoxine (B6) to prevent peripheral neuropathy is the standard LTBI treatment in transplant recipients, though timing and choice may vary by center.
Question 5: The MOST important preventive measure a transplant coordinator can reinforce to reduce surgical site infection (SSI) after transplant surgery is:
- Avoiding all physical activity for 12 months
- Strict hand hygiene and proper wound care as instructed by the surgical team (Correct answer)
- Taking prophylactic broad-spectrum antibiotics indefinitely
- Avoiding all contact with other people for 6 months
Correct answer: Strict hand hygiene and proper wound care as instructed by the surgical team
Hand hygiene and proper wound assessment/care are the most evidence-based interventions to prevent SSI and should be reinforced at every post-operative visit.
Question 6: Epstein-Barr virus (EBV) reactivation post-transplant is most concerning because it is associated with the development of:
- BK nephropathy
- Hepatitis C recurrence
- Post-transplant lymphoproliferative disorder (PTLD) (Correct answer)
- Cytomegalovirus retinitis
Correct answer: Post-transplant lymphoproliferative disorder (PTLD)
EBV-driven B-cell proliferation under immunosuppression can lead to PTLD, a potentially life-threatening malignancy that ranges from benign hyperplasia to aggressive lymphoma.
CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 2
When BK viremia is detected on surveillance in a kidney transplant recipient, the standard first intervention is: