CCTN Trivia 4 — Questions and Answers
Question 1: Which immunosuppressant is associated with the development of post-transplant lymphoproliferative disorder (PTLD)?
- Azathioprine
- Prednisone
- Belatacept
- Tacrolimus and overall high immunosuppression burden (Correct answer)
Correct answer: Tacrolimus and overall high immunosuppression burden
PTLD is associated with high overall immunosuppression burden, particularly with EBV-driven B-cell proliferation; no single drug is solely responsible.
Question 2: What does 'cold ischemia time' refer to in organ transplantation?
- Time the organ spends in the recipient's body before perfusion
- Duration from donor cross-clamp to organ implantation reperfusion (Correct answer)
- Time the recipient spends on bypass
- Duration of the transplant surgery
Correct answer: Duration from donor cross-clamp to organ implantation reperfusion
Cold ischemia time is the period from donor organ cooling/cross-clamp to reperfusion in the recipient, and longer times increase ischemia-reperfusion injury.
Question 3: Which antifungal agent is commonly used for prophylaxis against Candida infections in liver transplant recipients?
- Voriconazole
- Fluconazole (Correct answer)
- Amphotericin B
- Caspofungin
Correct answer: Fluconazole
Fluconazole is the standard antifungal prophylaxis for Candida in liver transplant recipients during the early post-transplant period.
Question 4: A heart transplant patient presents with endomyocardial biopsy showing grade 2R rejection. This corresponds to which type of rejection?
- Hyperacute rejection
- Moderate acute cellular rejection (Correct answer)
- Mild rejection requiring no treatment
- Chronic rejection
Correct answer: Moderate acute cellular rejection
Grade 2R on the ISHLT scale represents moderate acute cellular rejection, typically requiring augmented immunosuppression.
Question 5: Which laboratory value is most specific for monitoring liver graft function in the immediate post-transplant period?
- Serum creatinine
- Prothrombin time/INR (Correct answer)
- Serum sodium
- White blood cell count
Correct answer: Prothrombin time/INR
The liver synthesizes clotting factors, so PT/INR reflects liver synthetic function and is a sensitive early marker of graft performance.
Question 6: What is the significance of donor-specific antibodies (DSA) detected post-transplant?
- They improve graft tolerance
- They are associated with antibody-mediated rejection and reduced graft survival (Correct answer)
- They indicate successful engraftment
- They have no clinical significance
Correct answer: They are associated with antibody-mediated rejection and reduced graft survival
De novo DSAs are associated with antibody-mediated rejection (AMR) and are linked to worse long-term graft outcomes.
Question 7: A transplant nurse is educating a kidney recipient on sun protection. What is the primary reason transplant patients must rigorously avoid sun exposure?
- Tacrolimus causes photosensitivity rashes
- Immunosuppression dramatically increases risk of skin cancers, especially squamous cell carcinoma (Correct answer)
- Sun exposure reduces drug absorption
- UV light causes organ rejection
Correct answer: Immunosuppression dramatically increases risk of skin cancers, especially squamous cell carcinoma
Transplant recipients have up to 100 times increased risk of squamous cell carcinoma due to chronic immunosuppression impairing immune surveillance.
CCTN Trivia 4
Which immunosuppressant is associated with the development of post-transplant lymphoproliferative disorder (PTLD)?