CCTC Transplant Immunology and Pharmacology 2

Question 1

Which cytokine is primarily responsible for driving the differentiation of naive CD4+ T cells into Th17 cells?

Accepted Answer

TGF-β combined with IL-6

Answer

TGF-β combined with IL-6 drives naive CD4+ T cells toward the Th17 lineage, which produces IL-17 and contributes to certain rejection pathways.

Question 2

A transplant recipient on tacrolimus develops new-onset diabetes mellitus. What is the most likely mechanism?

Accepted Answer

Direct pancreatic beta-cell toxicity reducing insulin secretion

Answer

Tacrolimus causes direct pancreatic beta-cell toxicity that impairs insulin secretion, leading to post-transplant diabetes mellitus (PTDM).

Question 3

What is the mechanism by which belatacept prevents T-cell activation compared to calcineurin inhibitors?

Accepted Answer

It inhibits the CD28-B7 costimulatory pathway

Answer

Belatacept is a CTLA4-Ig fusion protein that blocks CD28-B7 costimulation, preventing the second signal required for full T-cell activation.

Question 4

Which HLA mismatch is most strongly associated with hyperacute rejection?

Accepted Answer

Preformed donor-specific antibodies against HLA class I

Answer

Preformed donor-specific antibodies (DSAs) against HLA class I antigens bind the graft endothelium immediately upon reperfusion, triggering complement activation and hyperacute rejection.

Question 5

A kidney transplant patient on mycophenolate mofetil (MMF) is started on ciprofloxacin. Which pharmacokinetic interaction is most concerning?

Accepted Answer

Ciprofloxacin reduces enterohepatic recirculation of MPA, lowering drug exposure

Answer

Fluoroquinolones alter gut flora that normally hydrolyze MPA-glucuronide conjugates, reducing enterohepatic recirculation and lowering mycophenolic acid (MPA) exposure by up to 30%.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Transplant Immunology and Pharmacology 2