CCTC Transplantation Management 2 — Questions and Answers
Question 1: Which immunosuppressive drug class works primarily by inhibiting calcineurin to block IL-2 production?
- mTOR inhibitors
- Calcineurin inhibitors (Correct answer)
- Antimetabolites
- Corticosteroids
Correct answer: Calcineurin inhibitors
Calcineurin inhibitors such as tacrolimus and cyclosporine block calcineurin, preventing IL-2 transcription and T-cell activation.
Question 2: A kidney transplant recipient presents with a serum creatinine rise of 25% above baseline at 3 months post-transplant. What is the most appropriate initial step?
- Immediately increase tacrolimus dose
- Obtain a kidney biopsy without further workup
- Rule out reversible causes such as dehydration and drug toxicity before biopsy (Correct answer)
- Start empiric antirejection therapy
Correct answer: Rule out reversible causes such as dehydration and drug toxicity before biopsy
Reversible causes including dehydration, drug toxicity, and obstruction should be excluded before proceeding to biopsy.
Question 3: Which Banff classification grade represents active antibody-mediated rejection in a kidney allograft?
- Banff 1a
- Banff 2b
- Banff 3
- Banff II AMR (Correct answer)
Correct answer: Banff II AMR
Banff II AMR (antibody-mediated rejection) is characterized by microvascular inflammation and C4d deposition with donor-specific antibodies.
Question 4: A liver transplant recipient develops biliary anastomotic stricture 6 months post-transplant. Which intervention is typically first-line?
- Surgical revision of the anastomosis
- Endoscopic retrograde cholangiopancreatography (ERCP) with dilation and stenting (Correct answer)
- Retransplantation
- Increased immunosuppression
Correct answer: Endoscopic retrograde cholangiopancreatography (ERCP) with dilation and stenting
ERCP with balloon dilation and stenting is the standard first-line treatment for post-transplant biliary anastomotic strictures.
Question 5: What is the mechanism of action of mycophenolate mofetil (MMF) in transplant immunosuppression?
- Inhibits mTOR signaling pathway
- Blocks T-cell calcineurin activation
- Inhibits inosine monophosphate dehydrogenase, reducing lymphocyte proliferation (Correct answer)
- Depletes B-cell populations via CD20 targeting
Correct answer: Inhibits inosine monophosphate dehydrogenase, reducing lymphocyte proliferation
MMF selectively inhibits IMPDH, blocking de novo purine synthesis required for lymphocyte proliferation.
Question 6: Which post-transplant complication is most closely associated with BK virus infection?
- Post-transplant lymphoproliferative disorder
- BK nephropathy in kidney transplant recipients (Correct answer)
- CMV colitis
- Aspergillus pneumonia
Correct answer: BK nephropathy in kidney transplant recipients
BK virus preferentially infects urothelial and tubular cells and is a leading cause of interstitial nephritis and allograft dysfunction in kidney recipients.
Question 7: A transplant coordinator is counseling a patient about tacrolimus. Which instruction is most important regarding grapefruit consumption?
- Grapefruit juice enhances renal clearance of tacrolimus
- Grapefruit should be avoided as it inhibits CYP3A4 and can significantly increase tacrolimus levels (Correct answer)
- Grapefruit has no interaction with tacrolimus
- Grapefruit juice can be consumed in moderation with dose adjustment
Correct answer: Grapefruit should be avoided as it inhibits CYP3A4 and can significantly increase tacrolimus levels
Grapefruit inhibits intestinal CYP3A4 metabolism, leading to unpredictably elevated tacrolimus blood levels and toxicity risk.
CCTC Transplantation Management 2
Which immunosuppressive drug class works primarily by inhibiting calcineurin to block IL-2 production?