CCTC Transplantation Management 5 — Questions and Answers
Question 1: A pancreas transplant recipient develops hyperglycemia and elevated serum amylase/lipase at 2 weeks post-transplant. Which complication should be suspected first?
- Hepatic artery thrombosis
- Pancreatic allograft rejection or pancreatitis (Correct answer)
- Cytomegalovirus colitis
- Calcineurin inhibitor nephrotoxicity
Correct answer: Pancreatic allograft rejection or pancreatitis
Early post-transplant hyperglycemia with elevated pancreatic enzymes suggests allograft pancreatitis or rejection requiring urgent evaluation.
Question 2: What is the primary role of the transplant coordinator during the organ offer process from UNOS?
- Independently accept or decline organ offers without physician input
- Coordinate clinical evaluation of the offer and facilitate communication between the donor team and transplant surgeon (Correct answer)
- Set allocation priorities for all patients on the waiting list
- Perform the donor crossmatch testing personally
Correct answer: Coordinate clinical evaluation of the offer and facilitate communication between the donor team and transplant surgeon
The coordinator serves as the critical communication hub, gathering donor information and facilitating timely physician decision-making on organ offers.
Question 3: Which parameter is used to calculate the Model for End-Stage Liver Disease (MELD) score for liver transplant prioritization?
- Serum albumin, bilirubin, prothrombin time, and ascites grade
- Serum creatinine, bilirubin, INR, and serum sodium (Correct answer)
- Child-Pugh score plus serum sodium
- Serum ALT, AST, alkaline phosphatase, and platelet count
Correct answer: Serum creatinine, bilirubin, INR, and serum sodium
The MELD-Na score uses creatinine, bilirubin, INR, and sodium to predict 90-day liver failure mortality and prioritize organ allocation.
Question 4: A kidney transplant recipient at 5 years post-transplant has stable graft function but develops new-onset donor-specific antibodies (DSA). What does this finding signify?
- Normal immune tolerance; no intervention needed
- Increased risk for antibody-mediated rejection and accelerated graft loss requiring monitoring and possible treatment (Correct answer)
- Evidence of successful weaning from immunosuppression
- Indication for immediate graft nephrectomy
Correct answer: Increased risk for antibody-mediated rejection and accelerated graft loss requiring monitoring and possible treatment
De novo DSA development is strongly associated with subclinical antibody-mediated rejection and accelerated graft failure, necessitating close surveillance.
Question 5: Which live vaccine is contraindicated in solid organ transplant recipients on maintenance immunosuppression?
- Inactivated influenza vaccine
- Pneumococcal polysaccharide vaccine (PPSV23)
- Measles-mumps-rubella (MMR) vaccine (Correct answer)
- Hepatitis B vaccine
Correct answer: Measles-mumps-rubella (MMR) vaccine
Live attenuated vaccines like MMR pose a risk of vaccine-strain infection in immunocompromised transplant recipients and are contraindicated post-transplant.
Question 6: What is the significance of a positive T-cell crossmatch (CDCXM) in kidney transplantation?
- It confirms ABO compatibility between donor and recipient
- It indicates preformed recipient antibodies against donor T cells, predicting risk of hyperacute rejection and contraindicating transplant (Correct answer)
- It demonstrates that the recipient requires no induction therapy
- It suggests a low risk of acute cellular rejection
Correct answer: It indicates preformed recipient antibodies against donor T cells, predicting risk of hyperacute rejection and contraindicating transplant
A positive T-cell CDC crossmatch indicates preformed anti-HLA antibodies against donor cells, which can cause immediate graft loss and typically precludes transplantation.
Question 7: A transplant coordinator notices that a recipient's CMV viral load has increased significantly despite standard prophylaxis. What condition does this suggest?
- CMV donor-derived transmission requiring ganciclovir adjustment
- CMV disease or breakthrough viremia requiring evaluation for antiviral resistance and treatment escalation (Correct answer)
- Normal CMV reactivation that requires no intervention
- BK virus co-infection mimicking CMV viremia
Correct answer: CMV disease or breakthrough viremia requiring evaluation for antiviral resistance and treatment escalation
Rising CMV viral loads despite prophylaxis may indicate antiviral resistance or end-organ disease, requiring physician evaluation and possible ganciclovir resistance testing.
CCTC Transplantation Management 5
A pancreas transplant recipient develops hyperglycemia and elevated serum amylase/lipase at 2 weeks post-transplant.
Which complication should be suspected first?