Theme: Complications of cadaveric organ transplantation
A Acute rejection
B Arterial thrombosis
C Azathioprine side-effects
D Chronic rejection
E Cyclosporin side-effects
F Cytomegalovirus infection
G Graft-versus-host disease
H Hyperacute rejection
I Malignancy
J Primary graft non-function
K Steroid side-effects
L Venous thrombosis
The following patients have all previously undergone cadaveric organ
transplantation. From the above list, select the most likely complication. The
items may be used once, more than once, or not at all.
Scenario 1
Incorrect
A 25-year-old woman with cystic fibrosis underwent a heart and lung transplant 4 months ago,
and is currently receiving triple immunotherapy. She attends the follow-up clinic for a routine
check-up. She reports sore gums and excessive facial hair. On examination she is hypertensive.
Urea & electrolyte results are as follows: Na+ 139 mmol/litre, K+ 5.7 mmol/litre, urea 9.9
mmol/litre, creatinine 140 µmol/litre.
B Your answer
E Correct answer
E – Cyclosporin side-effects
Cyclosporin A is an example of a calcineurin inhibitor. Cyclosporin-based triple
immunosuppression with corticosteroids and azathioprine remains the most popular regimen in
the UK. It is used prophylactically and therapeutically to address rejection following organ
transplantation. Sideeffects of cyclosporin include nephrotoxicity, hypertension, hirsutism,
tremor, gingival hyperplasia and hepatotoxicity. Long-term use increases the risk of development
of malignancy (5% of patients), most commonly basal or squamous cell carcinomas.
Scenario 2
, Incorrect
A 58-year-old man had a liver transplant 7 weeks ago. He attends The Emergency Department
with a 24-h history of malaise, fever and myalgia and respiratory distress going upstairs. He is
currently receiving triple immunosuppression. On examination, he is unwell and dyspnoeic at
rest. He has a pulse rate of 105/min, blood pressure is 95/60 mmHg, temperature is 38.3°C and
respiratory rate is 28 breaths/min. Oxygen saturation is 90% on air.
C Your answer
F Correct answer
F – Cytomegalovirus infection
In addition to the development of malignancy, immunosuppression increases the risk of
infection. Cytomegalovirus (CMV) is a member of the herpes group of viruses. Primary infection
in a seronegative individual who receives a graft from a seropositive donor typically occurs 6
weeks posttransplantation, and results in the most severe disease. The main symptoms of CMV
infection are usually non-specific and include fever, night sweats, fatigue and myalgia. Retinitis
is pathognomonic, but rarely seen in the transplant population. Respiratory distress, noticed at
first during exercise, may give a clue to early CMV pneumonitis. Patients may also present with
CMV encephalitis or gastrointestinal infection, characterised by dysphagia, diarrhoea, nausea
and abdominal pain. Reactivation of latent CMV infection may also occur in immunosuppressed
patients, although the infection is usually less severe.
Scenario 3
Incorrect
A 41-year-old woman underwent renal transplantation 18 months ago. She attends follow-up
clinic and is currently asymptomatic. On examination her blood pressure is 150/110 and
urinalysis reveals 3+ protein. Urine culture is negative. A renal ultrasound scan reveals a normal
collecting system. Renal biopsy demonstrates intrarenal arteriosclerosis with associated
glomerular atrophy and interstitial fibrosis.
K Your answer
D Correct answer
D – Chronic rejection
Chronic rejection is characterised clinically by a progressive deterioration in graft function
occurring months to years after transplantation and is associated with typical histological
changes of graft atherosclerosis and fibrosis. By contrast, acute rejection occurs within the first 3
months after transplantation, and hyperacute rejection occurs within hours. For the diagnosis of
, chronic rejection to be made, other causes of graft dysfunction must be excluded (eg infection,
calcineurin antagonist toxicity, etc), and a transplant graft biopsy is required to confirm the
diagnosis histologically. For renal transplantation, graft dysfunction is manifested by a rise in
serum creatinine as a result of progressive decline in the glomerular filtration rate. There is
associated proteinuria and worsening hypertension, with the diastolic component classically
rising in advance of the systolic component
Theme: Renal transplant
A Acute rejection
B Blood group mismatch
C Chronic rejection
D Hyperacute rejection
Match the following concerning transplantation. Each option may be used once,
more than once, or not at all.
Hyperacute rejection occurs immediately, as a result of a reaction from pre-
existing antibodies to the transplanted tissue, eg ABO blood type mismatch. Acute
rejection occurs as a result of HLA type mismatch, and is controlled by matching
donor and recipient HLA types and with immunosuppressive drugs. The humoral
immune system is responsible for chronic rejection, which can take months or
years to occur.
Scenario 1
Incorrect
The humoral system is responsible for this.
B Your answer
C Correct answer
C – Chronic rejection
Scenario 2
Incorrect
A Acute rejection
B Arterial thrombosis
C Azathioprine side-effects
D Chronic rejection
E Cyclosporin side-effects
F Cytomegalovirus infection
G Graft-versus-host disease
H Hyperacute rejection
I Malignancy
J Primary graft non-function
K Steroid side-effects
L Venous thrombosis
The following patients have all previously undergone cadaveric organ
transplantation. From the above list, select the most likely complication. The
items may be used once, more than once, or not at all.
Scenario 1
Incorrect
A 25-year-old woman with cystic fibrosis underwent a heart and lung transplant 4 months ago,
and is currently receiving triple immunotherapy. She attends the follow-up clinic for a routine
check-up. She reports sore gums and excessive facial hair. On examination she is hypertensive.
Urea & electrolyte results are as follows: Na+ 139 mmol/litre, K+ 5.7 mmol/litre, urea 9.9
mmol/litre, creatinine 140 µmol/litre.
B Your answer
E Correct answer
E – Cyclosporin side-effects
Cyclosporin A is an example of a calcineurin inhibitor. Cyclosporin-based triple
immunosuppression with corticosteroids and azathioprine remains the most popular regimen in
the UK. It is used prophylactically and therapeutically to address rejection following organ
transplantation. Sideeffects of cyclosporin include nephrotoxicity, hypertension, hirsutism,
tremor, gingival hyperplasia and hepatotoxicity. Long-term use increases the risk of development
of malignancy (5% of patients), most commonly basal or squamous cell carcinomas.
Scenario 2
, Incorrect
A 58-year-old man had a liver transplant 7 weeks ago. He attends The Emergency Department
with a 24-h history of malaise, fever and myalgia and respiratory distress going upstairs. He is
currently receiving triple immunosuppression. On examination, he is unwell and dyspnoeic at
rest. He has a pulse rate of 105/min, blood pressure is 95/60 mmHg, temperature is 38.3°C and
respiratory rate is 28 breaths/min. Oxygen saturation is 90% on air.
C Your answer
F Correct answer
F – Cytomegalovirus infection
In addition to the development of malignancy, immunosuppression increases the risk of
infection. Cytomegalovirus (CMV) is a member of the herpes group of viruses. Primary infection
in a seronegative individual who receives a graft from a seropositive donor typically occurs 6
weeks posttransplantation, and results in the most severe disease. The main symptoms of CMV
infection are usually non-specific and include fever, night sweats, fatigue and myalgia. Retinitis
is pathognomonic, but rarely seen in the transplant population. Respiratory distress, noticed at
first during exercise, may give a clue to early CMV pneumonitis. Patients may also present with
CMV encephalitis or gastrointestinal infection, characterised by dysphagia, diarrhoea, nausea
and abdominal pain. Reactivation of latent CMV infection may also occur in immunosuppressed
patients, although the infection is usually less severe.
Scenario 3
Incorrect
A 41-year-old woman underwent renal transplantation 18 months ago. She attends follow-up
clinic and is currently asymptomatic. On examination her blood pressure is 150/110 and
urinalysis reveals 3+ protein. Urine culture is negative. A renal ultrasound scan reveals a normal
collecting system. Renal biopsy demonstrates intrarenal arteriosclerosis with associated
glomerular atrophy and interstitial fibrosis.
K Your answer
D Correct answer
D – Chronic rejection
Chronic rejection is characterised clinically by a progressive deterioration in graft function
occurring months to years after transplantation and is associated with typical histological
changes of graft atherosclerosis and fibrosis. By contrast, acute rejection occurs within the first 3
months after transplantation, and hyperacute rejection occurs within hours. For the diagnosis of
, chronic rejection to be made, other causes of graft dysfunction must be excluded (eg infection,
calcineurin antagonist toxicity, etc), and a transplant graft biopsy is required to confirm the
diagnosis histologically. For renal transplantation, graft dysfunction is manifested by a rise in
serum creatinine as a result of progressive decline in the glomerular filtration rate. There is
associated proteinuria and worsening hypertension, with the diastolic component classically
rising in advance of the systolic component
Theme: Renal transplant
A Acute rejection
B Blood group mismatch
C Chronic rejection
D Hyperacute rejection
Match the following concerning transplantation. Each option may be used once,
more than once, or not at all.
Hyperacute rejection occurs immediately, as a result of a reaction from pre-
existing antibodies to the transplanted tissue, eg ABO blood type mismatch. Acute
rejection occurs as a result of HLA type mismatch, and is controlled by matching
donor and recipient HLA types and with immunosuppressive drugs. The humoral
immune system is responsible for chronic rejection, which can take months or
years to occur.
Scenario 1
Incorrect
The humoral system is responsible for this.
B Your answer
C Correct answer
C – Chronic rejection
Scenario 2
Incorrect
