CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers Flashcards

A transplant coordinator reviews CMV prophylaxis protocols. Which transplant recipient category is considered 'high risk' and typically requires 6 months of antiviral prophylaxis rather than 3 months?

Answer: CMV D+/R+ (both seropositive) lung transplant

Lung transplant recipients who are D+/R+ are considered high risk due to the graft being directly exposed to inhaled pathogens and the intensity of immunosuppression required, warranting extended 6-month prophylaxis.

Which of the following best describes the mechanism by which calcineurin inhibitors increase susceptibility to fungal infections in transplant recipients?

Answer: They suppress T-lymphocyte activation and IL-2 production, impairing cell-mediated immunity

Calcineurin inhibitors block T-cell activation by inhibiting calcineurin-mediated IL-2 transcription, impairing cell-mediated immunity, which is the primary defense against fungal pathogens.

A transplant recipient returns from international travel with fever, night sweats, and weight loss. Chest imaging shows upper lobe cavitary lesions. Which opportunistic infection must be immediately excluded?

Answer: Mycobacterium tuberculosis reactivation

Mycobacterium tuberculosis must be urgently excluded in any immunocompromised patient with upper lobe cavitary lesions, fever, and constitutional symptoms, as reactivation risk is significantly elevated post-transplant.

A transplant coordinator notes that a recipient's anti-HBs titer has dropped below 10 mIU/mL after receiving a liver from an HBsAg-negative, HBcAb-positive donor. What is the most appropriate long-term management strategy?

Answer: Start indefinite entecavir prophylaxis and monitor HBV DNA levels

Recipients of grafts from HBcAb-positive donors are at risk for de novo hepatitis B infection and require indefinite antiviral prophylaxis with a potent agent like entecavir along with regular HBV DNA monitoring.

Which of the following is the most appropriate screening test to evaluate a potential transplant recipient for latent Mycobacterium tuberculosis infection before transplantation?

Answer: Interferon-gamma release assay (IGRA) or tuberculin skin test (TST)

IGRA (e.g., QuantiFERON-TB Gold) or TST is recommended for pre-transplant latent TB screening; IGRA is preferred as it is unaffected by prior BCG vaccination and requires a single blood draw.

A transplant patient presents with new-onset headache, photophobia, and altered mentation 18 months after kidney transplantation. CSF analysis shows elevated opening pressure, India ink preparation reveals encapsulated yeast, and CSF cryptococcal antigen is positive. Which agent is used for induction therapy?

Answer: Liposomal amphotericin B plus flucytosine

Cryptococcal meningoencephalitis is treated with induction therapy using liposomal amphotericin B combined with flucytosine for at least 2 weeks, followed by consolidation and maintenance fluconazole.

When a transplant center receives a potential organ donor with confirmed West Nile Virus (WNV) encephalitis, what is the most appropriate course of action regarding organ utilization?

Answer: Consult UNOS/OPTN guidelines and consider individual risk-benefit analysis with recipient informed consent

WNV-positive donors require case-by-case evaluation per OPTN guidelines; organs may be considered for life-saving situations with full informed consent, as transmission risk exists but benefits may outweigh risks in select recipients.