Immunology: chronic graft 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.

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Microbiology · Immunology: chronic graft rejection

Sample item

Which feature characterises chronic rejection of a kidney graft, appearing months to years after transplantation?

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

The answer and the reasoning

C. Concentric intimal thickening of graft arteries with interstitial fibrosis, poorly responsive to more immunosuppression

Chronic rejection reflects ongoing alloimmune injury plus non-immune factors, producing obliterative vasculopathy, glomerulopathy and interstitial fibrosis with tubular atrophy. It is slowly progressive, largely irreversible and does not respond well to intensified immunosuppression.

Option by option

  • A. Fibrinoid necrosis of vessels with neutrophil plugging within minutes of reperfusion

    Fibrinoid necrosis within minutes describes hyperacute rejection from preformed antibodies.

  • B. Dense interstitial lymphocytes with tubulitis that resolve with pulse steroids

    Tubulitis responsive to steroids describes acute cellular rejection.

  • C. Concentric intimal thickening of graft arteries with interstitial fibrosis, poorly responsive to more immunosuppression (correct)

    Correct. Obliterative arteriopathy with fibrosis is the hallmark of chronic rejection.

  • D. Viral inclusions within tubular epithelial cells

    Viral inclusions suggest CMV or BK virus nephropathy, an infection rather than rejection.

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.

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Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is C, Concentric intimal thickening of graft arteries with interstitial fibrosis, poorly responsive to more immunosuppression. Chronic rejection reflects ongoing alloimmune injury plus non-immune factors, producing obliterative vasculopathy, glomerulopathy and interstitial fibrosis with tubular atrophy.

Why is "Fibrinoid necrosis of vessels with neutrophil plugging within minutes…" not the answer?

Fibrinoid necrosis within minutes describes hyperacute rejection from preformed antibodies.

Why is "Dense interstitial lymphocytes with tubulitis that resolve with pulse…" not the answer?

Tubulitis responsive to steroids describes acute cellular rejection.

Why is "Viral inclusions within tubular epithelial cells" not the answer?

Viral inclusions suggest CMV or BK virus nephropathy, an infection rather than rejection.

What concept does this question test?

It tests Immunology: chronic graft rejection in Microbiology. It is slowly progressive, largely irreversible and does not respond well to intensified immunosuppression.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: chronic graft 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.