CCTC Organ-Specific Transplant Knowledge 3 — Questions and Answers
Question 1: A liver transplant recipient on post-op day 3 develops a rise in AST/ALT to 10x normal with fever. What is the most likely diagnosis?
- Primary non-function
- Acute cellular rejection
- Hepatic artery thrombosis (Correct answer)
- Biliary anastomotic leak
Correct answer: Hepatic artery thrombosis
Hepatic artery thrombosis typically presents in the early post-transplant period with dramatic elevation of liver enzymes and is confirmed by Doppler ultrasound.
Question 2: Which immunosuppression medication requires therapeutic drug monitoring via trough levels and is nephrotoxic in kidney transplant recipients?
- Mycophenolate mofetil
- Prednisone
- Tacrolimus (Correct answer)
- Azathioprine
Correct answer: Tacrolimus
Tacrolimus is a calcineurin inhibitor requiring trough level monitoring due to its narrow therapeutic window and significant nephrotoxicity.
Question 3: In pediatric heart transplantation, which factor most strongly influences waitlist mortality compared to adults?
- ABO blood type
- Limited donor pool and size matching requirements (Correct answer)
- MELD score
- HLA sensitization
Correct answer: Limited donor pool and size matching requirements
Pediatric patients face higher waitlist mortality due to the limited pool of size-matched donors and the stringency of weight-appropriate organ matching.
Question 4: What is the role of the Lung Allocation Score (LAS) in lung transplantation?
- Rank candidates by wait time only
- Prioritize candidates based on urgency and expected post-transplant survival (Correct answer)
- Determine immunosuppression protocols
- Assess donor lung quality
Correct answer: Prioritize candidates based on urgency and expected post-transplant survival
The LAS was implemented to replace wait-time-based allocation and instead prioritize candidates who have the greatest medical urgency and expected benefit from transplantation.
Question 5: A kidney transplant recipient has a declining eGFR at 6 months post-transplant. Biopsy shows interstitial fibrosis and tubular atrophy (IFTA). What does this typically represent?
- Acute antibody-mediated rejection
- BK virus nephropathy
- Chronic allograft nephropathy (Correct answer)
- Calcineurin inhibitor toxicity only
Correct answer: Chronic allograft nephropathy
IFTA on biopsy at 6 months post-transplant with declining eGFR is the hallmark of chronic allograft nephropathy, a multifactorial process leading to progressive graft loss.
Question 6: Which post-transplant complication is specifically associated with Epstein-Barr virus (EBV) reactivation in solid organ recipients?
- CMV colitis
- Post-transplant lymphoproliferative disorder (PTLD) (Correct answer)
- BK virus nephropathy
- Kaposi's sarcoma
Correct answer: Post-transplant lymphoproliferative disorder (PTLD)
PTLD is a spectrum of lymphoid proliferations driven by EBV reactivation under immunosuppression, ranging from benign hyperplasia to aggressive lymphoma.
Question 7: During simultaneous pancreas-kidney (SPK) transplantation, which outcome measure confirms successful pancreas endocrine function?
- Normalized serum creatinine
- Insulin independence with euglycemia (Correct answer)
- Normal urine amylase
- Absence of ascites
Correct answer: Insulin independence with euglycemia
Insulin independence with normal blood glucose levels demonstrates restored endocrine function of the transplanted pancreas.
CCTC Organ-Specific Transplant Knowledge 3
A liver transplant recipient on post-op day 3 develops a rise in AST/ALT to 10x normal with fever.
What is the most likely diagnosis?