Certified Clinical Transplant Nurse Flashcards

Which of the following best describes 'hyperacute rejection' in solid organ transplantation?

Answer: Pre-formed recipient antibodies cause graft thrombosis within minutes to hours of reperfusion

Hyperacute rejection is caused by pre-formed donor-specific antibodies that bind immediately upon reperfusion, activating complement and causing microvascular thrombosis.

A transplant recipient is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. The PRIMARY indication for this medication in this population is:

Answer: Prophylaxis against Pneumocystis jirovecii pneumonia (PCP)

TMP-SMX is the drug of choice for Pneumocystis jirovecii pneumonia prophylaxis in immunosuppressed transplant recipients, typically given for 6-12 months post-transplant.

A patient awaiting a heart transplant has blood type O negative. This patient can receive a heart from:

Answer: O negative and O positive donors only

Blood type O is the universal donor for red cells, but for solid organs ABO compatibility (not exact match) is required; O recipients can receive from O+ or O- donors.

Which of the following is an absolute contraindication to living kidney donation?

Answer: Active malignancy with metastatic disease

Active malignancy, particularly with metastatic potential, is an absolute contraindication to living donation due to the risk of transmitting cancer to the immunosuppressed recipient.

Sirolimus (rapamycin) differs from tacrolimus in its mechanism of action by:

Answer: Inhibiting mTOR signaling to block T-cell proliferation

Sirolimus inhibits the mammalian target of rapamycin (mTOR), blocking cytokine-driven T-cell proliferation at the G1-to-S phase transition.

A renal transplant recipient who is 3 years post-transplant presents with gradually rising creatinine, proteinuria, and hypertension without episodes of acute rejection. Biopsy shows interstitial fibrosis and tubular atrophy. This pattern is MOST consistent with:

Answer: Chronic allograft nephropathy (interstitial fibrosis/tubular atrophy)

Interstitial fibrosis and tubular atrophy (IF/TA) is the histologic hallmark of chronic allograft nephropathy, the leading cause of late graft loss.

When counseling a female kidney transplant recipient of childbearing age about pregnancy, the transplant nurse should emphasize that:

Answer: Mycophenolate mofetil must be discontinued before conception due to teratogenicity

Mycophenolate mofetil (MMF) is a known teratogen associated with congenital malformations and must be switched to azathioprine at least 6 weeks before conception.