Transplant pathology: acute cellular rejection: practice question

A Pathology 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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Pathology · Transplant pathology: acute cellular rejection

Sample item

A renal transplant recipient is 4 weeks after surgery with rising creatinine and a fever. Graft biopsy shows interstitial lymphocytic infiltrate and lymphocytes within tubular epithelium, with negative C4d staining. What is the most appropriate treatment?

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

The answer and the reasoning

D. Pulse intravenous methylprednisolone

Interstitial infiltration with tubulitis and negative C4d indicates acute T-cell mediated rejection, which responds to high-dose corticosteroid pulses, with anti-thymocyte globulin for resistant or severe cases. Plasmapheresis and IVIG are for antibody-mediated rejection, in which C4d is positive.

Option by option

  • A. Withdrawal of all immunosuppressive drugs

    Stopping immunosuppression would worsen the rejection and lose the graft.

  • B. Plasmapheresis with intravenous immunoglobulin

    Plasmapheresis and IVIG treat antibody-mediated rejection, which shows C4d deposition and capillaritis.

  • C. Immediate graft nephrectomy

    Nephrectomy is reserved for irreversible graft failure and complications, not a first response.

  • D. Pulse intravenous methylprednisolone (correct)

    Correct. Pulse steroids are first-line for acute cellular 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 Pathology question

What is the answer to this Pathology question?

The best answer is D, Pulse intravenous methylprednisolone. Interstitial infiltration with tubulitis and negative C4d indicates acute T-cell mediated rejection, which responds to high-dose corticosteroid pulses, with anti-thymocyte globulin for resistant or severe cases.

Why is "Withdrawal of all immunosuppressive drugs" not the answer?

Stopping immunosuppression would worsen the rejection and lose the graft.

Why is "Plasmapheresis with intravenous immunoglobulin" not the answer?

Plasmapheresis and IVIG treat antibody-mediated rejection, which shows C4d deposition and capillaritis.

Why is "Immediate graft nephrectomy" not the answer?

Nephrectomy is reserved for irreversible graft failure and complications, not a first response.

What concept does this question test?

It tests Transplant pathology: acute cellular rejection in Pathology. Plasmapheresis and IVIG are for antibody-mediated rejection, in which C4d is positive.

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 Transplant pathology: acute cellular rejection?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.