CCTC Transplantation Management 3 — Questions and Answers
Question 1: During evaluation of a potential living kidney donor, which finding would most likely disqualify donation?
- Mild hypertension controlled with one medication
- GFR of 55 mL/min/1.73m² (Correct answer)
- Single episode of kidney stone 10 years ago
- BMI of 28
Correct answer: GFR of 55 mL/min/1.73m²
A GFR below 60 mL/min/1.73m² in a potential living donor indicates insufficient renal reserve to safely donate one kidney.
Question 2: What is the primary purpose of induction immunosuppression therapy in transplantation?
- To maintain long-term graft survival indefinitely
- To provide intense immunosuppression at the time of highest rejection risk around the transplant surgery (Correct answer)
- To treat active rejection episodes
- To prevent viral infections in the perioperative period
Correct answer: To provide intense immunosuppression at the time of highest rejection risk around the transplant surgery
Induction therapy provides high-intensity immunosuppression during the peritransplant period when alloreactivity is greatest.
Question 3: A heart transplant recipient's endomyocardial biopsy shows grade 2R (moderate) acute cellular rejection without hemodynamic compromise. What is the standard treatment?
- No treatment required; repeat biopsy in 6 months
- High-dose pulse corticosteroids (Correct answer)
- Immediate retransplantation
- Plasmapheresis and IVIG
Correct answer: High-dose pulse corticosteroids
Grade 2R rejection is typically treated with high-dose pulse IV methylprednisolone followed by an oral steroid taper.
Question 4: Which serology result pattern in a transplant candidate indicates immunity to hepatitis B virus through prior vaccination?
- HBsAg positive, anti-HBc positive, anti-HBs negative
- HBsAg negative, anti-HBc positive, anti-HBs negative
- HBsAg negative, anti-HBc negative, anti-HBs positive (Correct answer)
- HBsAg negative, anti-HBc positive, anti-HBs positive
Correct answer: HBsAg negative, anti-HBc negative, anti-HBs positive
Vaccination-induced immunity produces anti-HBs antibodies alone, without anti-HBc, because the vaccine contains only surface antigen.
Question 5: Which organ demonstrates the highest five-year graft survival rate in solid organ transplantation?
- Intestine
- Lung
- Kidney (Correct answer)
- Liver
Correct answer: Kidney
Kidney transplantation has the highest five-year graft survival rate among solid organs, exceeding 85% for living donor transplants.
Question 6: A transplant coordinator notes that a patient's tacrolimus trough level is 3 ng/mL at 2 years post-kidney transplant; the target is 5–8 ng/mL. What is the most appropriate action?
- No action; the level is acceptable for late post-transplant period
- Notify the transplant physician promptly for dose adjustment (Correct answer)
- Instruct the patient to take double the next dose
- Switch the patient to cyclosporine immediately
Correct answer: Notify the transplant physician promptly for dose adjustment
Subtherapeutic tacrolimus levels increase rejection risk and must be addressed by the physician with prompt dose adjustment.
Question 7: What does the term 'cold ischemia time' refer to in organ transplantation?
- Time from cardiac arrest of donor to organ procurement
- Time from organ cooling/preservation to reperfusion in the recipient (Correct answer)
- Time during which the recipient is on cardiopulmonary bypass
- Time from recipient anesthesia induction to organ implantation
Correct answer: Time from organ cooling/preservation to reperfusion in the recipient
Cold ischemia time is the interval from when the organ is flushed and cooled at procurement to when blood flow is restored in the recipient.
CCTC Transplantation Management 3
During evaluation of a potential living kidney donor, which finding would most likely disqualify donation?