CCTN Transplant Complications and Clinical Management 1 — Questions and Answers
Question 1: A kidney transplant patient presents with fever, graft tenderness, and rising serum creatinine 10 days post-transplant. What is the most likely diagnosis?
- Urinary tract infection
- Acute cellular rejection (Correct answer)
- Cyclosporine toxicity
- Renal artery stenosis
Correct answer: Acute cellular rejection
Fever, graft tenderness, and rising creatinine in the first weeks post-transplant are classic signs of acute cellular rejection requiring biopsy confirmation.
Question 2: Post-transplant lymphoproliferative disorder (PTLD) is most strongly associated with which viral infection?
- Cytomegalovirus (CMV)
- Epstein-Barr Virus (EBV) (Correct answer)
- BK polyomavirus
- Hepatitis C virus
Correct answer: Epstein-Barr Virus (EBV)
PTLD is most strongly associated with Epstein-Barr Virus (EBV), particularly in EBV-naive recipients receiving organs from EBV-seropositive donors.
Question 3: BK virus nephropathy in renal transplant recipients is managed primarily by which intervention?
- Increasing immunosuppression to control viral replication
- Reducing immunosuppression to allow immune control of the virus (Correct answer)
- Administering antiviral therapy with acyclovir
- Performing emergent nephrectomy of the graft
Correct answer: Reducing immunosuppression to allow immune control of the virus
BK nephropathy is managed by reducing immunosuppression to allow the recipient's immune system to control BK virus replication and limit nephropathy progression.
Question 4: Which complication is indicated by a sudden cessation of urine output, graft pain, and hematuria in an early post-kidney-transplant patient?
- Urinary tract infection
- Acute tubular necrosis
- Renal vein thrombosis (Correct answer)
- Lymphocele
Correct answer: Renal vein thrombosis
Sudden anuria with graft pain and hematuria in the early post-transplant period suggests renal vein thrombosis, a surgical emergency requiring immediate intervention.
Question 5: What is the recommended prophylaxis for Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients?
- Fluconazole
- Trimethoprim-sulfamethoxazole (TMP-SMX) (Correct answer)
- Acyclovir
- Voriconazole
Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX)
TMP-SMX (Bactrim) is the first-line prophylaxis for PJP in transplant recipients and also provides coverage against Toxoplasma and some urinary tract pathogens.
Question 6: A transplant patient on tacrolimus and TMP-SMX develops hyperkalemia. What is the most likely cause?
- Tacrolimus-induced hyperaldosteronism
- Combined effect of tacrolimus and TMP-SMX on renal potassium excretion (Correct answer)
- Dietary potassium excess alone
- Addison's disease triggered by immunosuppression
Correct answer: Combined effect of tacrolimus and TMP-SMX on renal potassium excretion
Both tacrolimus and TMP-SMX reduce renal potassium excretion through different mechanisms, and their combination commonly causes hyperkalemia in transplant recipients.
CCTN Transplant Complications and Clinical Management 1
A kidney transplant patient presents with fever, graft tenderness, and rising serum creatinine 10 days post-transplant.
What is the most likely diagnosis?