CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 5 — Questions and Answers
Question 1: 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?
- CMV D−/R− (both seronegative)
- CMV D+/R+ (both seropositive) lung transplant (Correct answer)
- CMV D−/R+ kidney transplant
- CMV D+/R+ kidney transplant on reduced immunosuppression
Correct 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.
Question 2: Which of the following best describes the mechanism by which calcineurin inhibitors increase susceptibility to fungal infections in transplant recipients?
- They directly inhibit neutrophil phagocytosis of fungal hyphae
- They suppress T-lymphocyte activation and IL-2 production, impairing cell-mediated immunity (Correct answer)
- They reduce IgG production by B lymphocytes, impairing humoral immunity
- They inhibit complement activation pathways critical for opsonization
Correct 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.
Question 3: 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?
- Cryptococcus neoformans meningitis
- Histoplasma capsulatum pulmonary infection
- Mycobacterium tuberculosis reactivation (Correct answer)
- Nocardia farcinica pulmonary abscess
Correct 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.
Question 4: 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?
- No treatment required since donor was HBsAg-negative
- Administer hepatitis B vaccine booster series and monitor titers annually
- Start indefinite entecavir prophylaxis and monitor HBV DNA levels (Correct answer)
- Start lamivudine for 12 months then reassess
Correct 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.
Question 5: Which of the following is the most appropriate screening test to evaluate a potential transplant recipient for latent Mycobacterium tuberculosis infection before transplantation?
- Sputum acid-fast bacilli culture
- Chest X-ray alone
- Interferon-gamma release assay (IGRA) or tuberculin skin test (TST) (Correct answer)
- Bronchoscopy with BAL mycobacterial culture
Correct 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.
Question 6: 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?
- Fluconazole 400 mg daily orally
- Liposomal amphotericin B plus flucytosine (Correct answer)
- Voriconazole 6 mg/kg IV twice daily
- Micafungin 150 mg IV daily
Correct 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.
Question 7: 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?
- Proceed with procurement as WNV cannot be transmitted via solid organ transplantation
- Decline all organs due to absolute contraindication to transplantation
- Consult UNOS/OPTN guidelines and consider individual risk-benefit analysis with recipient informed consent (Correct answer)
- Accept organs only if donor nucleic acid testing (NAT) is negative for WNV
Correct 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.
CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 5
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?