CCTN Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Her blood type is rare, so only donors with the identical ABO group can be offered to her: cPRA measures HLA antibodies, not ABO blood group. ABO compatibility is a separate matching step.

Preformed HLA antibodies would make about 98% of potential donors crossmatch-incompatible: Correct. cPRA estimates the percentage of donors in the population against whom the candidate has unacceptable HLA antibodies; pregnancy, transfusion and prior transplant are the classic sensitizing events.

She has a 98% chance of rejecting any kidney she receives in the first post-operative year: cPRA is not a rejection probability. It describes the breadth of preformed antibodies and therefore the difficulty of finding a compatible donor.

Her immune system is suppressed, so she must wait until white cell counts return to normal: Sensitization means heightened antibody-mediated reactivity to HLA, the opposite of immunosuppression, and it is unrelated to the white cell count.

cPRA = the percentage of the donor population a candidate is likely incompatible with because of preformed anti-HLA antibodies. Sensitizing events: pregnancy, blood transfusion, previous transplant.

Answer: B

Percutaneous liver biopsy to look for acute cellular rejection: Acute cellular rejection usually appears later (around days 5–30) and does not typically cause this abrupt, massive transaminase rise; vascular patency is checked first.

Doppler ultrasound of the hepatic artery and portal vein: Correct. A sharp rise in transaminases with failing synthetic function early after transplant suggests hepatic artery thrombosis; Doppler ultrasound is the rapid first-line test, because the graft may need urgent revascularization or retransplant.

Endoscopic retrograde cholangiography to look for an anastomotic stricture: Biliary strictures develop later and cause a cholestatic pattern (rising bilirubin and alkaline phosphatase), not an abrupt hepatocellular injury on day 2.

Serum CMV PCR to screen for early cytomegalovirus hepatitis: CMV disease is rare in the first post-operative week; the clinical picture suggests an urgent vascular problem.

Early massive transaminase rise and graft dysfunction after liver transplant = rule out hepatic artery thrombosis with Doppler ultrasound immediately.

Answer: C

Pulse IV methylprednisolone alone, followed by a prednisone taper: Steroid pulses are first-line for acute T-cell-mediated rejection; on their own they are usually not enough for antibody-mediated rejection.

Stopping tacrolimus and starting sirolimus to protect the graft from toxicity: Reducing immunosuppression strength during active antibody-mediated rejection would worsen it; this does not treat AMR.

Plasmapheresis to remove antibodies, with IV immune globulin: Correct. Antibody-mediated rejection (DSA plus C4d and capillaritis) is treated by removing and modulating antibodies, typically plasmapheresis with IVIG, sometimes adding rituximab or other agents per protocol.

Treatment-dose ganciclovir, since C4d staining indicates viral infection: C4d is a complement-split product that marks antibody-mediated injury, not cytomegalovirus infection.

Cellular rejection: steroid pulses (anti-thymocyte globulin if refractory). Antibody-mediated rejection (DSA, C4d, capillaritis): plasmapheresis plus IVIG, ± rituximab.

Answer: A

Just before the 0800 dose is given: Correct. A trough is the lowest concentration, drawn immediately before the next scheduled dose (about 12 hours after the last twice-daily dose).

Two hours after the 0800 dose is given: Two hours after dosing is near the peak and would overestimate exposure compared with the trough target.

At 1400, halfway between the two doses: A mid-interval level matches neither peak nor trough, so it cannot be compared with standard trough targets.

Any time of day, as long as it is fasting: Timing relative to the dose is essential for interpreting tacrolimus levels; fasting alone is not enough.

Calcineurin-inhibitor trough = draw right before the next dose; hold the dose until the sample is drawn, then give it.

Answer: B

Live attenuated intranasal influenza vaccine: Live vaccines are contraindicated in immunosuppressed transplant recipients.

Inactivated injectable influenza vaccine: Correct. Inactivated vaccines are safe; annual inactivated influenza vaccination is recommended for transplant recipients and their household contacts.

Measles-mumps-rubella (MMR) vaccine: MMR is a live vaccine and should be given before transplant, not after.

Live varicella (chickenpox) vaccine: Live varicella vaccine is contraindicated after transplant; susceptible candidates should be vaccinated before transplant.

After transplant: avoid live vaccines (MMR, varicella, intranasal influenza, yellow fever, oral typhoid); give inactivated vaccines. Complete live vaccines before transplant when possible.

Answer: A

Kidney paired donation, in which the incompatible pairs swap donors: Correct. In paired exchange each donor gives to the other pair's compatible recipient, so both recipients get compatible living-donor kidneys.

Directed deceased donation, in which she is listed as a future donor for him: Directed deceased donation refers to organs from a deceased donor and does not let a living, incompatible spouse help now.

ABO-incompatible transplant, in which he is desensitized to accept her kidney: Desensitization is a separate strategy for transplanting directly across ABO; it does not involve swapping donors with another pair.

Non-directed donation, in which her husband must then wait on the list: Non-directed (altruistic) donation gives no direct benefit to her husband unless it is part of a paired chain.

Kidney paired donation (exchange) lets incompatible living donor–recipient pairs swap donors; chains can start with a non-directed donor.