CCTN Transplant Complications and Clinical Management 2 — Questions and Answers
Question 1: Cytomegalovirus (CMV) infection in transplant recipients is most severe in which donor-recipient combination?
- CMV donor negative / recipient positive (D-/R+)
- CMV donor positive / recipient negative (D+/R-) (Correct answer)
- CMV donor positive / recipient positive (D+/R+)
- CMV donor negative / recipient negative (D-/R-)
Correct answer: CMV donor positive / recipient negative (D+/R-)
The D+/R- combination carries the highest CMV risk because the recipient has no prior immunity against primary CMV infection transmitted from the seropositive donor.
Question 2: Renal artery stenosis after kidney transplantation typically presents with which clinical findings?
- Gross hematuria and flank pain
- Hypertension that is difficult to control and rising creatinine (Correct answer)
- Fever and leukocytosis
- Peripheral edema and weight gain
Correct answer: Hypertension that is difficult to control and rising creatinine
Transplant renal artery stenosis classically presents with refractory hypertension and worsening allograft function, often diagnosed by Doppler ultrasound.
Question 3: A liver transplant patient develops ascites and elevated liver enzymes 2 weeks post-operatively. What complication should be suspected first?
- Acute rejection
- Hepatic artery thrombosis (Correct answer)
- Bile leak
- Drug-induced hepatotoxicity
Correct answer: Hepatic artery thrombosis
Hepatic artery thrombosis is a serious early complication of liver transplant that compromises biliary and hepatic perfusion, presenting with liver dysfunction and ascites.
Question 4: What is the most important nursing assessment parameter in the first 24 hours after kidney transplantation?
- Blood glucose monitoring every 4 hours
- Hourly urine output measurement (Correct answer)
- Daily weight measurement only
- Oral intake documentation
Correct answer: Hourly urine output measurement
Hourly urine output is the most critical early indicator of graft function — sudden decrease can indicate vascular complications, obstruction, or rejection.
Question 5: Which post-transplant complication is caused by lymphatic disruption during surgery and typically presents as a fluid collection near the kidney?
- Urinoma
- Hematoma
- Lymphocele (Correct answer)
- Perinephric abscess
Correct answer: Lymphocele
Lymphocele is a collection of lymphatic fluid that forms near the transplanted kidney due to lymphatic disruption during surgery and may compress the ureter or iliac vein.
Question 6: Post-transplant erythrocytosis (PTE) in kidney transplant recipients is best managed by which medication class?
- Erythropoiesis-stimulating agents
- ACE inhibitors or angiotensin receptor blockers (Correct answer)
- Calcium channel blockers
- Diuretics
Correct answer: ACE inhibitors or angiotensin receptor blockers
ACE inhibitors and ARBs effectively reduce erythrocytosis in post-transplant patients by decreasing erythropoietin-stimulated red cell production.
CCTN Transplant Complications and Clinical Management 2
Cytomegalovirus (CMV) infection in transplant recipients is most severe in which donor-recipient combination?