CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 4

Question 1

A kidney transplant recipient on tacrolimus and mycophenolate develops fever, productive cough, and bilateral infiltrates 3 months post-transplant. Bronchoalveolar lavage reveals silver-staining cysts. Which organism is most likely responsible?

Accepted Answer

Pneumocystis jirovecii

Answer

Pneumocystis jirovecii pneumonia (PJP) presents with bilateral infiltrates and is identified by silver staining of BAL specimens, typically occurring 1–6 months post-transplant in inadequately prophylaxed patients.

Question 2

A transplant coordinator is reviewing post-transplant prophylaxis orders. Trimethoprim-sulfamethoxazole (TMP-SMX) is prescribed primarily to prevent which infection in the early post-transplant period?

Accepted Answer

Pneumocystis jirovecii pneumonia

Answer

TMP-SMX is the first-line prophylactic agent against Pneumocystis jirovecii pneumonia and also provides coverage against Toxoplasma and some bacterial urinary pathogens in transplant recipients.

Question 3

Which antifungal agent is most commonly used for prophylaxis against invasive Aspergillus infections in lung transplant recipients during the first year post-transplant?

Accepted Answer

Voriconazole

Answer

Voriconazole is the preferred agent for Aspergillus prophylaxis in lung transplant recipients due to its broad mold coverage and oral bioavailability, though drug interactions with calcineurin inhibitors require close monitoring.

Question 4

A liver transplant recipient presents 8 months post-transplant with hematuria and a declining creatinine. Urine PCR is positive for BK virus with a viral load of 10^7 copies/mL. What is the most appropriate initial management?

Accepted Answer

Reduce immunosuppression

Answer

The cornerstone of BK virus nephropathy management is reduction of immunosuppression, particularly mycophenolate mofetil and/or calcineurin inhibitors, to restore antiviral immune responses.

Question 5

A transplant coordinator is counseling a heart transplant patient about Toxoplasma gondii risk. Which donor-recipient serostatus combination carries the highest risk for post-transplant toxoplasmosis?

Accepted Answer

Donor positive / Recipient negative

Answer

A seropositive donor transmitting latent Toxoplasma to a seronegative recipient (D+/R−) carries the highest risk, as the recipient lacks pre-existing immunity and is heavily immunosuppressed.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 4