CCTC Long-Term Recipient Management 2 — Questions and Answers
Question 1: A kidney transplant recipient at 3 years post-transplant has a serum creatinine that has slowly risen from 1.2 to 2.1 mg/dL over 6 months. The most likely diagnosis is:
- Acute cellular rejection
- Chronic allograft nephropathy (Correct answer)
- Calcineurin inhibitor toxicity
- Urinary tract infection
Correct answer: Chronic allograft nephropathy
Slowly progressive decline in renal function years after transplant is the hallmark of chronic allograft nephropathy (interstitial fibrosis/tubular atrophy).
Question 2: Which vaccine is CONTRAINDICATED in solid organ transplant recipients on immunosuppression?
- Inactivated influenza vaccine
- Pneumococcal polysaccharide vaccine
- Live attenuated varicella zoster vaccine (Correct answer)
- Recombinant hepatitis B vaccine
Correct answer: Live attenuated varicella zoster vaccine
Live attenuated vaccines are contraindicated in immunocompromised transplant recipients due to risk of vaccine-strain infection.
Question 3: A liver transplant recipient develops hypertension, hyperlipidemia, and new-onset diabetes 2 years post-transplant. These findings together are best described as:
- Calcineurin inhibitor nephrotoxicity
- Post-transplant metabolic syndrome (Correct answer)
- Chronic rejection
- Opportunistic infection sequelae
Correct answer: Post-transplant metabolic syndrome
The cluster of hypertension, dyslipidemia, and new-onset diabetes after transplant (NODAT) defines post-transplant metabolic syndrome, largely driven by immunosuppression.
Question 4: Which malignancy has the highest increased incidence in long-term transplant recipients compared to the general population?
- Breast cancer
- Colon cancer
- Non-melanoma skin cancer (Correct answer)
- Prostate cancer
Correct answer: Non-melanoma skin cancer
Non-melanoma skin cancers (squamous and basal cell) are dramatically more common in transplant recipients, with squamous cell carcinoma occurring up to 100 times more often.
Question 5: A transplant coordinator is counseling a 5-year post-kidney-transplant recipient about sun protection. The PRIMARY reason is:
- Tacrolimus causes photosensitivity rash
- Immunosuppression increases skin cancer risk (Correct answer)
- Mycophenolate causes UV sensitivity
- Prednisone thins the skin and increases burn risk
Correct answer: Immunosuppression increases skin cancer risk
Chronic immunosuppression impairs immune surveillance against skin carcinogenesis, making sun protection critical for long-term recipients.
Question 6: A heart transplant recipient at 7 years post-transplant is found to have diffuse concentric luminal narrowing on coronary angiography. This is most consistent with:
- Atherosclerosis from pre-existing coronary disease
- Cardiac allograft vasculopathy (Correct answer)
- Calcineurin inhibitor-induced vasospasm
- Hypertensive coronary remodeling
Correct answer: Cardiac allograft vasculopathy
Cardiac allograft vasculopathy (CAV) causes diffuse, concentric intimal hyperplasia affecting the entire coronary tree and is distinct from native atherosclerosis.
Question 7: When monitoring tacrolimus levels in a stable long-term transplant recipient, the coordinator should know that target trough levels are typically:
- Higher than early post-transplant targets
- Lower than early post-transplant targets (Correct answer)
- The same as immediate post-operative targets
- Only checked annually after 2 years
Correct answer: Lower than early post-transplant targets
Immunosuppression is typically minimized over time; tacrolimus trough targets decrease from early post-transplant levels (10-15 ng/mL) to lower maintenance levels (5-8 ng/mL).
CCTC Long-Term Recipient Management 2
A kidney transplant recipient at 3 years post-transplant has a serum creatinine that has slowly risen from 1.2 to 2.1 mg/dL over 6 months.
The most likely diagnosis is: