CMSRN Transplant 3 — Questions and Answers
Question 1: A patient is being evaluated for kidney transplant candidacy. Which finding is an absolute contraindication?
- Age 68 years
- BMI of 32 kg/m²
- Active metastatic malignancy (Correct answer)
- Controlled type 2 diabetes
Correct answer: Active metastatic malignancy
Active malignancy is an absolute contraindication to transplant due to the risk of accelerated tumor growth under immunosuppression.
Question 2: Which post-transplant malignancy is most strongly linked to Epstein-Barr virus (EBV) reactivation?
- Kaposi's sarcoma
- Squamous cell carcinoma of the skin
- Post-transplant lymphoproliferative disorder (PTLD) (Correct answer)
- Hepatocellular carcinoma
Correct answer: Post-transplant lymphoproliferative disorder (PTLD)
PTLD is primarily driven by EBV reactivation under immunosuppression and ranges from benign hyperplasia to aggressive lymphoma.
Question 3: A renal transplant recipient is started on fluconazole for a fungal infection. The nurse anticipates which medication adjustment?
- Increase tacrolimus dose due to reduced absorption
- Decrease tacrolimus dose due to CYP3A4 inhibition (Correct answer)
- Stop mycophenolate mofetil temporarily
- Double the prednisone dose
Correct answer: Decrease tacrolimus dose due to CYP3A4 inhibition
Fluconazole inhibits CYP3A4, dramatically increasing tacrolimus levels and requiring a significant dose reduction to avoid toxicity.
Question 4: In deceased-donor organ allocation, which criterion gives highest priority for kidney offers to a recipient on the waiting list?
- Longest time on dialysis
- Zero HLA mismatch with the donor (Correct answer)
- Recipient body weight closest to donor
- Geographic proximity to donor hospital
Correct answer: Zero HLA mismatch with the donor
Zero HLA antigen mismatch (full-house match) confers mandatory sharing across UNOS regions due to superior long-term outcomes.
Question 5: A living-related donor is being evaluated for kidney donation. Which finding would disqualify the donor?
- GFR of 85 mL/min/1.73m²
- One prior urinary tract infection
- Bilateral kidney stones with residual nephrocalcinosis (Correct answer)
- BMI of 27 kg/m²
Correct answer: Bilateral kidney stones with residual nephrocalcinosis
Bilateral nephrolithiasis with nephrocalcinosis places the remaining kidney at risk post-donation and disqualifies the candidate.
Question 6: The nurse assesses a lung transplant patient on post-op day 7 who has new hypoxemia, bilateral infiltrates, and decreased FEV1. No fever or leukocytosis is present. This presentation suggests:
- Bacterial pneumonia
- Primary graft dysfunction
- Acute cellular rejection (Correct answer)
- Pleural effusion
Correct answer: Acute cellular rejection
Acute cellular rejection in lung transplant classically presents with dyspnea, hypoxemia, and radiographic infiltrates without infection markers, typically within days to months post-transplant.
Question 7: Which medication used for transplant rejection prophylaxis works by blocking IL-2 receptor (CD25) to prevent T-cell proliferation?
- Mycophenolate mofetil
- Sirolimus
- Basiliximab (Correct answer)
- Belatacept
Correct answer: Basiliximab
Basiliximab is a monoclonal antibody targeting CD25 (IL-2 receptor alpha chain), used as induction therapy to block early T-cell activation.
CMSRN Transplant 3
A patient is being evaluated for kidney transplant candidacy.
Which finding is an absolute contraindication?