Immunology: transplant rejection: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Microbiology · Immunology: transplant rejection

Sample item

Six weeks after a renal transplant, a patient's creatinine rises. Graft biopsy shows interstitial lymphocytic infiltrate with tubulitis and no C4d staining in peritubular capillaries. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Pulse intravenous methylprednisolone

Acute cellular rejection is mediated by recipient T cells reacting to donor HLA antigens and shows interstitial lymphocytes with tubulitis. It typically responds to high-dose corticosteroids, with anti-thymocyte globulin for steroid-resistant disease. C4d positivity would point to antibody-mediated rejection instead.

Option by option

  • A. Starting intravenous ganciclovir alone

    Antivirals treat CMV disease, whose biopsy shows viral inclusions rather than tubulitis.

  • B. Plasma exchange with rituximab

    Plasma exchange and rituximab are used for antibody-mediated rejection, which is C4d positive.

  • C. Pulse intravenous methylprednisolone (correct)

    Correct. Cell-mediated rejection responds to pulse corticosteroids.

  • D. Stopping all immunosuppression and removing the graft

    Withdrawing immunosuppression would cause irreversible loss, and the graft is salvageable here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Microbiology questions

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is C, Pulse intravenous methylprednisolone. Acute cellular rejection is mediated by recipient T cells reacting to donor HLA antigens and shows interstitial lymphocytes with tubulitis.

Why is "Starting intravenous ganciclovir alone" not the answer?

Antivirals treat CMV disease, whose biopsy shows viral inclusions rather than tubulitis.

Why is "Plasma exchange with rituximab" not the answer?

Plasma exchange and rituximab are used for antibody-mediated rejection, which is C4d positive.

Why is "Stopping all immunosuppression and removing the graft" not the answer?

Withdrawing immunosuppression would cause irreversible loss, and the graft is salvageable here.

What concept does this question test?

It tests Immunology: transplant rejection in Microbiology. It typically responds to high-dose corticosteroids, with anti-thymocyte globulin for steroid-resistant disease. C4d positivity would point to antibody-mediated rejection instead.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Immunology: transplant rejection?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.