CCTN Transplant Complications and Clinical Management 3

Question 1

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

Accepted Answer

High-dose intravenous corticosteroids (pulse steroids)

Answer

Initiate plasmapheresis

Answer

Increase maintenance tacrolimus dose only

Answer

Start rituximab infusion

Question 2

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

Accepted Answer

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

Answer

Both show the same histologic pattern on biopsy

Answer

Rejection always causes anuria while CNI toxicity does not

Answer

CNI toxicity responds to pulse steroids

Question 3

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

Accepted Answer

Pancreatic graft thrombosis

Answer

Dietary non-compliance

Answer

Steroid-induced hyperglycemia

Answer

Tacrolimus-induced diabetes

Question 4

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

Accepted Answer

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

Answer

It occurs in less than 10% of transplant recipients

Answer

It resolves spontaneously within 6 months

Answer

It only occurs with cyclosporine, not tacrolimus

Question 5

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?

Accepted Answer

Obtain a kidney transplant biopsy to determine the cause

Answer

Increase tacrolimus dose empirically

Answer

Reassure and recheck in one month

Answer

Start pulse steroids empirically without biopsy

Question 6

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

Accepted Answer

Cardiovascular disease (CAD, MI, stroke)

Answer

Pulmonary embolism

Answer

Arrhythmia from tacrolimus

Answer

Aortic aneurysm