CMSRN Transplant 4 — Questions and Answers
Question 1: A patient with end-stage liver disease secondary to hepatitis C is being evaluated for liver transplant. Which score is used to prioritize liver allocation in the United States?
- Child-Pugh score
- APACHE II score
- MELD score (Correct answer)
- SOFA score
Correct answer: MELD score
The Model for End-Stage Liver Disease (MELD) score, based on creatinine, bilirubin, and INR, determines priority for liver transplant allocation in the US.
Question 2: A renal transplant patient is noted to have a rising creatinine 3 weeks post-op along with a urine cytology showing decoy cells. Which complication should the nurse suspect?
- Acute cellular rejection
- BK virus nephropathy (Correct answer)
- Urinary tract infection
- Ureteral obstruction
Correct answer: BK virus nephropathy
BK virus nephropathy presents with rising creatinine and decoy cells (virally infected tubular cells) on urine cytology and is managed by reducing immunosuppression.
Question 3: Post-transplant hypertension is most commonly caused by which of the following?
- Renal artery stenosis of the transplanted kidney
- Calcineurin inhibitor toxicity (vasoconstriction) (Correct answer)
- Acute rejection-mediated fluid retention
- Corticosteroid-induced mineralocorticoid excess
Correct answer: Calcineurin inhibitor toxicity (vasoconstriction)
Calcineurin inhibitors (tacrolimus, cyclosporine) cause renal afferent arteriolar vasoconstriction leading to hypertension and nephrotoxicity.
Question 4: Which type of allograft rejection occurs within minutes to hours after reperfusion and is caused by preformed donor-specific antibodies?
- Acute humoral rejection
- Hyperacute rejection (Correct answer)
- Chronic rejection
- Accelerated acute rejection
Correct answer: Hyperacute rejection
Hyperacute rejection is mediated by preformed anti-donor antibodies that activate complement immediately upon reperfusion, causing irreversible thrombosis.
Question 5: A nurse is teaching a kidney transplant recipient about signs of rejection to report. Which symptom cluster should prompt immediate notification?
- Mild constipation and fatigue
- Decreased urine output, flank pain, and low-grade fever (Correct answer)
- Nausea after taking tacrolimus
- Weight gain of 1 lb over one week
Correct answer: Decreased urine output, flank pain, and low-grade fever
Decreased urine output, graft site pain, and fever are classic signs of acute renal transplant rejection and require urgent evaluation.
Question 6: Sirolimus (rapamycin) differs from tacrolimus in its mechanism of action because it:
- Inhibits calcineurin and reduces IL-2 transcription
- Blocks the mTOR pathway to inhibit T-cell proliferation (Correct answer)
- Depletes B lymphocytes via anti-CD20 binding
- Inhibits inosine monophosphate dehydrogenase
Correct answer: Blocks the mTOR pathway to inhibit T-cell proliferation
Sirolimus binds FKBP12 but inhibits mTOR rather than calcineurin, blocking T-cell proliferation in response to IL-2 signaling.
Question 7: A transplant coordinator is discussing organ preservation with a new nurse. Which solution is most commonly used for cold storage of kidneys during transport?
- Normal saline
- Lactated Ringer's solution
- University of Wisconsin (UW) solution (Correct answer)
- Hypertonic saline
Correct answer: University of Wisconsin (UW) solution
University of Wisconsin solution is the standard cold storage solution for kidney preservation, maintaining cellular integrity for up to 30–36 hours.
CMSRN Transplant 4
A patient with end-stage liver disease secondary to hepatitis C is being evaluated for liver transplant.
Which score is used to prioritize liver allocation in the United States?