CCTN Trivia 3 — Questions and Answers
Question 1: Which viral infection is the most common opportunistic infection in solid organ transplant recipients?
- Epstein-Barr virus (EBV)
- Cytomegalovirus (CMV) (Correct answer)
- Herpes simplex virus (HSV)
- Varicella-zoster virus (VZV)
Correct answer: Cytomegalovirus (CMV)
CMV is the most prevalent opportunistic viral infection post-transplant due to immunosuppression, often presenting 1–3 months after transplant.
Question 2: What is the primary risk associated with a CMV-negative recipient receiving an organ from a CMV-positive donor?
- Graft-versus-host disease
- Primary CMV infection leading to CMV disease (Correct answer)
- Hyperacute rejection
- Increased tacrolimus toxicity
Correct answer: Primary CMV infection leading to CMV disease
A D+/R- mismatch places the recipient at highest risk for primary CMV disease because they lack prior immunity.
Question 3: Mycophenolate mofetil (MMF) works primarily by inhibiting which enzyme?
- Calcineurin
- mTOR
- Inosine monophosphate dehydrogenase (IMPDH) (Correct answer)
- Dihydrofolate reductase
Correct answer: Inosine monophosphate dehydrogenase (IMPDH)
MMF inhibits IMPDH, blocking de novo purine synthesis and selectively suppressing lymphocyte proliferation.
Question 4: Which organism causes PCP (Pneumocystis pneumonia) in immunocompromised transplant patients?
- Aspergillus fumigatus
- Candida albicans
- Pneumocystis jirovecii (Correct answer)
- Cryptococcus neoformans
Correct answer: Pneumocystis jirovecii
Pneumocystis jirovecii (formerly P. carinii) causes PCP, a serious fungal pneumonia requiring TMP-SMX prophylaxis post-transplant.
Question 5: What is the most common cause of late graft loss in kidney transplant recipients beyond the first year?
- Hyperacute rejection
- Acute cellular rejection
- Chronic allograft nephropathy (Correct answer)
- Surgical complications
Correct answer: Chronic allograft nephropathy
Chronic allograft nephropathy, now often called interstitial fibrosis/tubular atrophy, is the leading cause of late kidney graft failure.
Question 6: A kidney transplant nurse notes a patient's tacrolimus trough level is 18 ng/mL (target 8–12). What is the priority nursing action?
- Administer the next dose as scheduled
- Hold the next dose and notify the transplant physician (Correct answer)
- Double the next tacrolimus dose
- Obtain a urine culture
Correct answer: Hold the next dose and notify the transplant physician
A supratherapeutic tacrolimus level increases nephrotoxicity and neurotoxicity risk; the physician must be notified to adjust dosing.
Question 7: Which of the following is a contraindication to living kidney donation?
- Single episode of resolved UTI
- Controlled well-managed hypertension with no end-organ damage in a donor over 18
- Uncontrolled diabetes mellitus (Correct answer)
- BMI of 27
Correct answer: Uncontrolled diabetes mellitus
Uncontrolled diabetes mellitus is a contraindication to living donation because it significantly increases the donor's risk of future kidney failure.
CCTN Trivia 3
Which viral infection is the most common opportunistic infection in solid organ transplant recipients?