CCTN Certified Clinical Transplant Nurse 4 — Questions and Answers
Question 1: Which of the following best describes 'hyperacute rejection' in solid organ transplantation?
- T-cell mediated rejection occurring 5-7 days post-transplant
- Pre-formed recipient antibodies cause graft thrombosis within minutes to hours of reperfusion (Correct answer)
- Chronic fibrosis of the graft occurring years after transplant
- NK cell-mediated rejection occurring in the first 24 hours
Correct 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.
Question 2: A transplant recipient is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. The PRIMARY indication for this medication in this population is:
- Prevention of cytomegalovirus infection
- Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
- Treatment of bacterial UTI
- Prevention of fungal esophagitis
Correct 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.
Question 3: A patient awaiting a heart transplant has blood type O negative. This patient can receive a heart from:
- Any ABO blood type donor
- Only O negative donors
- O negative and O positive donors only (Correct answer)
- O and A donors only
Correct 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.
Question 4: Which of the following is an absolute contraindication to living kidney donation?
- Age over 55 years
- Single kidney donor with a GFR of 90 mL/min/1.73m²
- Active malignancy with metastatic disease (Correct answer)
- BMI of 28 kg/m²
Correct 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.
Question 5: Sirolimus (rapamycin) differs from tacrolimus in its mechanism of action by:
- Blocking calcineurin and inhibiting IL-2 production
- Inhibiting mTOR signaling to block T-cell proliferation (Correct answer)
- Depleting T-lymphocytes through complement-mediated lysis
- Blocking co-stimulatory signals between antigen-presenting cells and T-cells
Correct 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.
Question 6: 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:
- Acute antibody-mediated rejection
- Chronic allograft nephropathy (interstitial fibrosis/tubular atrophy) (Correct answer)
- BK virus nephropathy
- Recurrent primary disease
Correct 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.
Question 7: When counseling a female kidney transplant recipient of childbearing age about pregnancy, the transplant nurse should emphasize that:
- Pregnancy is absolutely contraindicated for at least 10 years post-transplant
- Mycophenolate mofetil must be discontinued before conception due to teratogenicity (Correct answer)
- Tacrolimus levels typically need to be increased during pregnancy
- Breastfeeding is encouraged to reduce maternal immunosuppression needs
Correct 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.
CCTN Certified Clinical Transplant Nurse 4
Which of the following best describes 'hyperacute rejection' in solid organ transplantation?