Question Bank


Want to stay up to date on transplantation? Want to test your knowledge? Here’s your chance! Introducing a new IPTA member benefit, the IPTA question. Members will have access to new questions with each newsletter with additional questions and answers available on the website. Each question will be accompanied by references to explain the correct and incorrect answers. Can be used as a teaching tool for students, residents and fellows as well.

A child comes to you for evaluation for kidney transplant. Which of the following is an absolute contraindication for kidney transplantation?

  1.   Malnutrition
  2.   HIV
  3.   Active Infection
  4.   Oxalosis
  5.   All of the above

Correct Answer C: Active Infection

While we would like all of our patients to be at the optimal nutritional status at the time of transplantation, this is not always the case. It is definitely not a contraindication. HIV was an absolute contraindicated until the recent antivirals were developed. There are centers that will transplant HIV + patients with good outcomes. Oxalosis was an absolute contraindication until recent years because of the risk of reoccurrence. Now it can be treated with combined liver kidney transplantation. Active infections should be treated before transplantation and immunosuppression to prevent increased morbidity and mortality from infection.

  1. McKay DB, Milford EL, Sayegh MH. Clinical aspects of renal transplantation. In: The Kidney, 5th ed, Brenner BM, Rector FC (Eds), Saunders, Philadelphia 1995.
  2. Evaluation of potential renal transplantation. In: Handbook of Kidney Transplantation, 4th ed., Danovitch GM (Ed), Lippincott, Williams & Wilkins, Philadelphia 2005.
  3. Review of transplantation in HIV patients during the HAART era. Pelletier SJ, Norman SP, Christensen LL, Stock PG, Port FK, Merion RM. Clin Transpl. 2004:63-82. Review.

Tacrolimus and Cyclosporine are both calcineurin inhibitors, with some minor differences. Which of the following is a true statement regarding these two CNIs?

  1.   Tacrolimus is more potent than cyclosporine on a molecular weight basis
  2.   Cyclosporine is a macrolide antibiotic
  3.   Tacrolimus increases expression of TGF-beta
  4.   Both have better absorption if taken with a fatty meal.

Correct Answer A: Tacrolimus is more potent than cyclosporine on a molecular weight basis

Tacrolimus is more potent than cyclosporine on a molecular weight basis hence 1-10mg tables of tacrolimus and 100s for cyclosporine. Tacrolimus is a macrolide antibiotic, not cyclosporine. Cyclosporine increases expression of TGF-beta and not tacrolimus. Both Cyclosporine and tacrolimus have some decreased absorption when ingested with a fatty meal, and it is recommended that they be taken on an empty stomach, if possible

  1. Shin GT, Khanna A, Ding R, et al. In vivo expression of transforming growth factor-beta1 in humans: stimulation by cyclosporine. Transplantation 1998; 65:313.
  2. Slattery C, Campbell E, McMorrow T, Ryan MP. Cyclosporine A-induced renal fibrosis: a role for epithelial-mesenchymal transition. Am J Pathol 2005; 167:395.
  3. Bekersky I, Dressler D, Mekki Q. Effect of time of meal consumption on bioavailability of a single oral 5 mg tacrolimus dose. J Clin Pharmacol 2001; 41:289.