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SU13.1-4 | Transplantation — Graded Quiz
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Three weeks after a kidney transplant, a recipient on adequate immunosuppression develops rising creatinine and a tender graft. Biopsy shows a dense infiltrate of T lymphocytes within the graft. Which type of rejection is most consistent with these findings?
Correct. Acute rejection occurs over days to weeks, is largely T-cell mediated, and typically presents with graft dysfunction and a lymphocytic infiltrate on biopsy; it is usually treatable by augmenting immunosuppression.
Acute rejection (days–weeks) is predominantly T-cell mediated and often reversible with treatment; contrast with hyperacute (minutes–hours, antibody-mediated) and chronic (months–years, progressive fibrosis).
Graft dysfunction at three weeks with a T-cell infiltrate on biopsy is acute (cellular) rejection — days-to-weeks onset, T-cell mediated, and usually responsive to increased immunosuppression.
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Several years after a kidney transplant, a recipient shows a slow, progressive decline in graft function with interstitial fibrosis, tubular atrophy and vascular narrowing on biopsy, poorly responsive to increased immunosuppression. Which type of rejection does this picture represent?
Correct. Chronic rejection develops over months to years as progressive fibrosis, tubular atrophy and vascular changes causing slow graft loss; it responds poorly to immunosuppression and is the major cause of late graft failure.
Chronic rejection (months–years) causes progressive, largely irreversible fibrosis and is the main cause of late graft failure, unlike the often-treatable acute rejection.
Slow graft decline over years with fibrosis, tubular atrophy and vascular narrowing, poorly responsive to immunosuppression, is chronic rejection — the leading cause of late graft loss.
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A transplant recipient is maintained on mycophenolate mofetil as part of triple therapy. This drug suppresses rejection mainly by inhibiting purine synthesis and thereby blocking lymphocyte proliferation. To which class does it belong?
Correct. Mycophenolate (like azathioprine) is an antiproliferative agent: it blocks lymphocyte proliferation by inhibiting purine/nucleotide synthesis, complementing the calcineurin inhibitor and steroid in triple therapy.
Antiproliferative agents (mycophenolate, azathioprine) block lymphocyte proliferation and form the second arm of standard triple immunosuppression alongside a calcineurin inhibitor and a corticosteroid.
Mycophenolate blocks lymphocyte proliferation by inhibiting purine synthesis, making it an antiproliferative agent (the same class as azathioprine), distinct from calcineurin inhibitors and steroids.
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A long-term transplant recipient on triple immunosuppression presents with an opportunistic infection. Which statement best explains the principal trade-off that underlies all chronic immunosuppressive therapy?
Correct. Immunosuppression that protects the graft also blunts defences against pathogens and tumour surveillance, so recipients face increased risks of (often opportunistic) infection and malignancy — the central trade-off that drives careful dosing and monitoring.
Every immunosuppressive regimen balances rejection prevention against the dose-related hazards of opportunistic infection and malignancy; minimising drug exposure while preventing rejection is the goal.
The fundamental trade-off of immunosuppression is that protecting the graft from rejection also raises the risk of infection (including opportunistic) and malignancy, which is why dosing is carefully balanced.
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A family has just been told that their relative is brain-stem dead. The treating team's single most important rule before raising organ donation is to separate the news of death from the request for organs. What is this principle called?
Correct. Decoupling means never breaking the news of death and asking for organs in the same conversation: tell the family their relative has died, let that be understood, and only then — separately and compassionately — raise donation.
Decoupling — separating the disclosure of death from the donation request — is the single most important rule in donation counselling; it respects the family and improves the quality of consent.
The rule of separating the breaking of death-news from the donation request is called decoupling — it allows the family to absorb the death before any donation conversation.
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A healthy adult wishes to donate one kidney to her sibling. Under THOTA (1994, amended 2011), living donation between such individuals is permitted with relative ease primarily because the donor and recipient fall into which legally recognised category?
Correct. THOTA defines near relatives (such as siblings, parents, children and spouse), for whom living-related donation is permitted more readily; unrelated donation faces additional authorisation safeguards to prevent commercial trade.
Under THOTA, near relatives may donate to one another with fewer hurdles; donation by unrelated persons requires authorisation-committee approval to guard against commercial dealing in organs.
THOTA permits living-related donation between near relatives (e.g. siblings, parents, children, spouse) with relative ease; donation outside this category requires extra authorisation to prevent organ trade.
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