Certified Clinical Transplant Nurse Flashcards

A kidney transplant recipient on tacrolimus develops a serum creatinine rise from 1.2 to 2.8 mg/dL on post-op day 5. The most appropriate next step is:

Answer: Obtain a renal biopsy to differentiate rejection from tacrolimus nephrotoxicity

A renal biopsy is the gold standard to distinguish acute rejection from calcineurin inhibitor nephrotoxicity, as treatment differs significantly.

Which of the following cytomegalovirus (CMV) serostatus combinations carries the HIGHEST risk for CMV disease post-transplant?

Answer: Donor positive / Recipient negative (D+/R-)

A CMV-seropositive donor transplanted into a seronegative recipient (D+/R-) poses the highest risk because the recipient has no pre-existing immunity.

A liver transplant patient on mycophenolate mofetil (MMF) reports persistent diarrhea. The nurse should first:

Answer: Switch to enteric-coated mycophenolate sodium to reduce GI side effects

Enteric-coated mycophenolate sodium delivers the drug to the small intestine, reducing upper GI side effects including diarrhea.

During a living donor kidney evaluation, the potential donor is found to have a glomerular filtration rate (GFR) of 72 mL/min/1.73 m². The transplant team should:

Answer: Evaluate further with a 24-hour urine collection and repeat measurement

A borderline GFR requires further evaluation including 24-hour urine for creatinine clearance and protein to ensure safe residual function post-donation.

Post-liver transplant, a patient develops fever, right upper quadrant pain, and elevated liver enzymes on day 10. Doppler ultrasound shows absent hepatic artery flow. This finding is MOST consistent with:

Answer: Hepatic artery thrombosis

Hepatic artery thrombosis typically presents with fever, elevated enzymes, and absent arterial flow on Doppler in the early post-operative period.

The immunosuppression protocol known as induction therapy in transplantation refers to:

Answer: Intensive immunosuppression given perioperatively to reduce early rejection risk

Induction therapy uses potent immunosuppressive agents perioperatively to reduce the immune response when the allograft is most vulnerable to rejection.

A heart transplant patient is being evaluated six months post-transplant with an endomyocardial biopsy. The pathology report reads 'Grade 2R acute cellular rejection.' According to ISHLT grading, this indicates:

Answer: Moderate rejection requiring augmented immunosuppression

Grade 2R (moderate) acute cellular rejection per ISHLT 2004 criteria typically warrants treatment with pulse steroids or augmented immunosuppression.