CCTC Long-Term Recipient Management 3

Question 1

A renal transplant recipient presents 18 months post-transplant with fever, fatigue, and a CD4 count of 120 cells/µL. CMV viremia is negative. Which opportunistic infection should be highest on the differential?

Accepted Answer

Pneumocystis jirovecii pneumonia (PJP)

Answer

PJP prophylaxis is often discontinued at 6-12 months, leaving patients vulnerable; low CD4 count and fever in an immunosuppressed host strongly suggests PJP.

Question 2

BK virus nephropathy in kidney transplant recipients is best managed initially by:

Accepted Answer

Reducing overall immunosuppression

Answer

The primary treatment for BK nephropathy is reduction of immunosuppression to allow immune reconstitution and viral clearance; no antiviral has proven efficacy.

Question 3

A transplant coordinator is reviewing a 4-year post-liver-transplant patient's labs and notes eGFR of 35 mL/min/1.73m². Which immunosuppressant is most implicated in this long-term complication?

Accepted Answer

Calcineurin inhibitors (tacrolimus/cyclosporine)

Answer

Chronic calcineurin inhibitor (CNI) nephrotoxicity is a leading cause of chronic kidney disease in non-renal solid organ transplant recipients.

Question 4

Which test is the recommended screening for post-transplant lymphoproliferative disorder (PTLD) in high-risk patients?

Accepted Answer

EBV viral load monitoring

Answer

EBV-negative recipients who receive EBV-positive organs are at highest risk for PTLD; serial EBV PCR monitoring allows early detection and immunosuppression reduction.

Question 5

A kidney transplant recipient at 2 years post-transplant has proteinuria of 1.8 g/day on urinalysis. The BEST next step is:

Accepted Answer

Perform a kidney transplant biopsy

Answer

New-onset significant proteinuria requires allograft biopsy to distinguish recurrent glomerulonephritis, chronic rejection, and de novo glomerular disease.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Long-Term Recipient Management 3