CCTC Long-Term Recipient Management 5 — Questions and Answers
Question 1: A kidney transplant coordinator receives a call from a recipient at 4 years post-transplant reporting decreased urine output and 3 kg weight gain over 3 days. The FIRST priority is:
- Schedule a routine clinic visit within 2 weeks
- Direct the patient to the emergency department immediately (Correct answer)
- Advise increased fluid intake and recheck in 48 hours
- Adjust the diuretic dose over the phone
Correct answer: Direct the patient to the emergency department immediately
Acute decrease in urine output with rapid weight gain suggests acute rejection or obstruction requiring urgent evaluation; this warrants immediate emergency assessment.
Question 2: Which mTOR inhibitor-related side effect most commonly leads to drug discontinuation in transplant recipients?
- Nephrotoxicity
- Mouth ulcers (stomatitis) and impaired wound healing (Correct answer)
- Neurotoxicity with tremors
- Bone marrow suppression causing neutropenia
Correct answer: Mouth ulcers (stomatitis) and impaired wound healing
Stomatitis (mouth sores), impaired wound healing, and hyperlipidemia are hallmark side effects of mTOR inhibitors (sirolimus/everolimus) that frequently cause dose reduction or discontinuation.
Question 3: A transplant coordinator is educating a recipient about signs of acute rejection at their long-term follow-up. Which symptom is MOST specific for acute renal allograft rejection?
- Generalized fatigue and malaise
- Fever, graft tenderness, and decreased urine output (Correct answer)
- Nausea and loss of appetite
- Peripheral edema in the lower extremities
Correct answer: Fever, graft tenderness, and decreased urine output
The classic triad of acute rejection includes graft tenderness/pain, decreased urine output, and fever, though many episodes are now subclinical and detected only by rising creatinine.
Question 4: Which serum marker is used to monitor for BK virus replication in kidney transplant recipients BEFORE it causes nephropathy?
- Serum BK virus PCR (viremia)
- Urine cytology for decoy cells followed by plasma BK PCR (Correct answer)
- Serum creatinine trend alone
- Urine culture for BK virus
Correct answer: Urine cytology for decoy cells followed by plasma BK PCR
The recommended screening sequence is urine cytology for decoy cells (sensitive screen) followed by plasma BK PCR quantification to confirm viremia before nephropathy develops.
Question 5: A transplant recipient on sirolimus wants to start a family. The transplant coordinator should counsel that:
- Sirolimus is safe in pregnancy and should be continued
- Sirolimus is teratogenic and must be discontinued before conception (Correct answer)
- Pregnancy is absolutely contraindicated after transplant
- Mycophenolate is the preferred agent during pregnancy
Correct answer: Sirolimus is teratogenic and must be discontinued before conception
Sirolimus is classified as potentially teratogenic and should be switched (typically to azathioprine or low-dose tacrolimus) at least 6 weeks before planned conception.
Question 6: At a 5-year post-transplant visit, a recipient's blood pressure is consistently 158/96 mmHg. The coordinator knows that the PREFERRED antihypertensive class in transplant recipients with proteinuria is:
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Alpha-1 blockers
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs are preferred in transplant recipients with proteinuria due to their renoprotective effects, though potassium and creatinine must be monitored closely.
Question 7: A transplant coordinator is reviewing a 10-year post-transplant recipient's chart and notes they have never had a colonoscopy. Current guidelines recommend colorectal cancer screening for transplant recipients:
- Starting at the same age as the general population with no modifications
- Starting at age 50 or 10 years post-transplant, whichever comes first, given increased risk (Correct answer)
- Only if they have a family history of colorectal cancer
- Starting at age 40 regardless of transplant history
Correct answer: Starting at age 50 or 10 years post-transplant, whichever comes first, given increased risk
Transplant recipients have an increased risk of colorectal cancer due to chronic immunosuppression; screening should begin at age 50 or 10 years post-transplant, whichever is earlier.
CCTC Long-Term Recipient Management 5
A kidney transplant coordinator receives a call from a recipient at 4 years post-transplant reporting decreased urine output and 3 kg weight gain over 3 days.
The FIRST priority is: