Transplant Flashcards
7 cards from real CMSRN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Transplant flashcards as text
A kidney transplant recipient on day 3 post-op develops fever, oliguria, and graft tenderness. Which complication is most likely?
Answer: Acute cellular rejection
Acute cellular rejection typically presents days to weeks post-transplant with fever, oliguria, and graft tenderness, and is T-cell mediated.
Which immunosuppressant combination is standard maintenance therapy for solid organ transplant recipients?
Answer: Tacrolimus + mycophenolate mofetil + prednisone
The standard triple immunosuppression regimen is tacrolimus, mycophenolate mofetil, and a corticosteroid.
A liver transplant patient develops jaundice, elevated liver enzymes, and pruritus 6 months post-transplant. These findings are most consistent with:
Answer: Chronic rejection (ductopenic rejection)
Chronic rejection, also called ductopenic rejection, presents months to years post-transplant with progressive cholestasis and loss of bile ducts.
The nurse is caring for a post-renal transplant patient whose tacrolimus trough level is 18 ng/mL (therapeutic range 8–12 ng/mL). Which assessment finding is most concerning?
Answer: Serum creatinine rise from 1.0 to 1.8 mg/dL
Supratherapeutic tacrolimus causes nephrotoxicity; a rising creatinine indicates calcineurin inhibitor-induced renal injury requiring dose reduction.
Which post-transplant infection is associated with a CD4+ count below 200 cells/µL and reactivation of a latent opportunistic organism?
Answer: Pneumocystis jirovecii pneumonia (PJP)
PJP occurs when profound immunosuppression lowers CD4+ counts, reactivating latent Pneumocystis jirovecii; TMP-SMX prophylaxis is standard.
A heart transplant recipient presents with dyspnea, fatigue, and an endomyocardial biopsy showing Grade 2R rejection. The most appropriate treatment is:
Answer: High-dose IV methylprednisolone pulse therapy
ISHLT Grade 2R moderate acute cellular rejection is treated with high-dose IV corticosteroid pulse therapy.
Which laboratory finding is most indicative of primary graft non-function immediately after liver transplantation?
Answer: INR > 3.0 unresponsive to vitamin K with persistent encephalopathy
Primary non-function is characterized by failure to produce bile, coagulopathy unresponsive to treatment, encephalopathy, and rapidly rising bilirubin requiring urgent retransplant.