CCTC Transplantation Management 4 — Questions and Answers
Question 1: A lung transplant recipient develops new-onset obstructive spirometry changes at 18 months post-transplant without identifiable infection. What syndrome does this most likely represent?
- Primary graft dysfunction
- Acute fibrinous organizing pneumonia
- Bronchiolitis obliterans syndrome (BOS) (Correct answer)
- Pulmonary allograft vasculopathy
Correct answer: Bronchiolitis obliterans syndrome (BOS)
BOS is the clinical manifestation of chronic lung allograft dysfunction, presenting as a progressive decline in FEV1 without other identifiable cause.
Question 2: Which donor characteristic most significantly increases the risk of delayed graft function (DGF) in kidney transplantation?
- Donor age under 30
- Expanded criteria donor (ECD) or donation after cardiac death (DCD) (Correct answer)
- Living related donor
- ABO-compatible donor
Correct answer: Expanded criteria donor (ECD) or donation after cardiac death (DCD)
DCD and ECD kidneys have higher rates of DGF due to warm ischemia injury and donor comorbidities reducing organ quality.
Question 3: Post-transplant lymphoproliferative disorder (PTLD) is most commonly driven by which virus?
- Cytomegalovirus (CMV)
- BK virus
- Epstein-Barr virus (EBV) (Correct answer)
- Hepatitis C virus (HCV)
Correct answer: Epstein-Barr virus (EBV)
EBV-driven B-cell proliferation under immunosuppression is the most common cause of PTLD following solid organ transplantation.
Question 4: Which United Network for Organ Sharing (UNOS) policy change made kidney allocation more equitable by prioritizing compatibility and medical urgency over waiting time?
- The 2014 Kidney Allocation System (KAS) reform (Correct answer)
- The MELD score introduction in 2002
- The DonorNet implementation in 2008
- The EPTS/KDPI scoring system introduced in 2018
Correct answer: The 2014 Kidney Allocation System (KAS) reform
The 2014 KAS overhaul introduced EPTS/KDPI matching, reducing sensitized patient disadvantage and prioritizing biological compatibility.
Question 5: A transplant coordinator is managing a patient with a panel reactive antibody (PRA) of 85%. What does this indicate about the transplant candidate?
- The patient has a 85% chance of graft survival
- The patient is highly sensitized with antibodies against 85% of the donor pool, making matching difficult (Correct answer)
- The patient requires 85% less immunosuppression post-transplant
- The patient has 85% kidney function remaining
Correct answer: The patient is highly sensitized with antibodies against 85% of the donor pool, making matching difficult
A high PRA indicates broad sensitization, meaning few compatible donors exist and the risk of hyperacute rejection is elevated.
Question 6: Which prophylactic regimen is standard for Pneumocystis jirovecii pneumonia (PJP) prevention in solid organ transplant recipients?
- Oral fluconazole for 6 months
- Trimethoprim-sulfamethoxazole (TMP-SMX) for at least 6–12 months post-transplant (Correct answer)
- Inhaled pentamidine monthly for life
- Voriconazole for 3 months
Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX) for at least 6–12 months post-transplant
TMP-SMX is the preferred PJP prophylaxis agent due to its efficacy, low cost, and additional coverage against other opportunistic pathogens.
Question 7: In the context of ABO-incompatible kidney transplantation, which desensitization approach is commonly used to reduce isohemagglutinin titers?
- High-dose corticosteroids alone
- Plasmapheresis combined with IVIG and anti-CD20 therapy (rituximab) (Correct answer)
- Extended cold ischemia with organ washing
- Conversion to tacrolimus monotherapy
Correct answer: Plasmapheresis combined with IVIG and anti-CD20 therapy (rituximab)
Desensitization for ABO-incompatible transplantation typically involves plasmapheresis to remove antibodies combined with rituximab to deplete B cells.
CCTC Transplantation Management 4
A lung transplant recipient develops new-onset obstructive spirometry changes at 18 months post-transplant without identifiable infection.
What syndrome does this most likely represent?