Transplant Complications and Clinical Management Flashcards

What is the first-line treatment for acute cellular rejection confirmed by biopsy?

Answer: High-dose intravenous corticosteroids (pulse steroids)

High-dose IV methylprednisolone (pulse steroids) is the first-line treatment for acute cellular rejection, typically given for 3–5 days.

Calcineurin inhibitor nephrotoxicity can be distinguished from acute rejection by which finding?

Answer: CNI nephrotoxicity is associated with high drug levels and tubular vacuolization without significant inflammation

CNI nephrotoxicity typically shows isometric tubular vacuolization on biopsy with elevated drug levels, while rejection shows inflammatory cell infiltration.

A pancreas transplant recipient develops hyperglycemia 1 week post-transplant. What is the most urgent complication to rule out?

Answer: Pancreatic graft thrombosis

Pancreatic graft thrombosis is the most common cause of early pancreas graft loss and presents with sudden hyperglycemia — vascular imaging is urgently required.

Which statement about calcineurin inhibitor-induced hypertension in transplant recipients is accurate?

Answer: It affects over 50% of transplant recipients and increases cardiovascular risk

CNI-induced hypertension affects the majority of transplant recipients and significantly contributes to cardiovascular morbidity and mortality in this population.

A kidney transplant recipient's serum creatinine rises from 1.2 to 2.8 mg/dL at 6 months post-transplant without symptoms. What is the recommended next step?

Answer: Obtain a kidney transplant biopsy to determine the cause

A significant rise in creatinine requires biopsy to differentiate between rejection, CNI toxicity, BK nephropathy, and other causes before initiating treatment.

Which cardiovascular complication is the leading cause of death in long-term kidney transplant recipients?

Answer: Cardiovascular disease (CAD, MI, stroke)

Cardiovascular disease is the leading cause of death in long-term kidney transplant recipients, driven by traditional risk factors amplified by CNIs, steroids, and chronic kidney disease.