CCTC Transplant Immunology and Pharmacology 5

Question 1

Which of the following best explains why ABO blood group compatibility is critical in solid organ transplantation?

Accepted Answer

ABO antigens expressed on vascular endothelium are targeted by naturally occurring isohemagglutinins causing hyperacute rejection

Answer

ABO antigens are expressed on graft vascular endothelium, and preformed naturally occurring IgM isohemagglutinins cause immediate complement activation and hyperacute rejection in ABO-incompatible transplants.

Question 2

A transplant coordinator is counseling a patient about the long-term risks of calcineurin inhibitor therapy. Which of the following is a well-established chronic complication?

Accepted Answer

Chronic allograft nephrotoxicity from afferent arteriolar vasoconstriction

Answer

Chronic CNI nephrotoxicity results from sustained afferent arteriolar vasoconstriction, causing ischemic injury and progressive interstitial fibrosis/tubular atrophy in both native and transplanted kidneys.

Question 3

What is the significance of panel reactive antibody (PRA) percentage in transplant candidate evaluation?

Accepted Answer

It reflects the breadth of HLA sensitization, predicting difficulty finding a compatible donor

Answer

PRA (or calculated PRA, cPRA) reflects the percentage of donors against whom a candidate has preformed HLA antibodies, directly predicting wait time and crossmatch failure probability.

Question 4

Which immunologic mechanism primarily mediates chronic allograft vasculopathy (CAV) in heart transplant recipients?

Accepted Answer

Chronic alloimmune injury driven by both cellular and humoral responses causing intimal proliferation

Answer

CAV results from ongoing alloimmune injury—both T-cell mediated and antibody-mediated—stimulating smooth muscle proliferation and intimal hyperplasia throughout the coronary tree.

Question 5

A liver transplant coordinator notes that a patient's tacrolimus trough has dropped from 8 ng/mL to 3 ng/mL after starting rifampin for tuberculosis. What is the mechanism?

Accepted Answer

Rifampin is a potent CYP3A4 and P-glycoprotein inducer, accelerating tacrolimus metabolism

Answer

Rifampin potently induces CYP3A4 and P-glycoprotein, dramatically accelerating tacrolimus hepatic metabolism and intestinal efflux, often requiring 3–5 fold dose increases.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Transplant Immunology and Pharmacology 5