This part of our ASCP MLS mock practice series, Part 31, focuses on Immunology – Transplantation. It includes 100 practice questions (2621–2720) designed to strengthen your knowledge of graft types, mechanisms of rejection, GVHD, histocompatibility testing, and immunosuppressive therapy.
By reviewing these questions, you can test your understanding of how the immune system responds to transplantation and prepare more effectively for the ASCP MLS exam.
100 MCQs (2621-2720):
- Which type of graft is between genetically identical individuals?
a) Autograft
b) Allograft
c) Isograft
d) Xenograft - A graft transplanted from one species to another is called:
a) Autograft
b) Xenograft
c) Allograft
d) Isograft - Which graft is taken from one part of the body and transplanted to another site in the same individual?
a) Allograft
b) Autograft
c) Isograft
d) Xenograft - The most common type of graft in human organ transplantation is:
a) Autograft
b) Allograft
c) Xenograft
d) Isograft - Which immune cells are primarily responsible for graft rejection?
a) Neutrophils
b) T lymphocytes
c) B lymphocytes
d) NK cells - Which type of rejection occurs within minutes to hours after transplantation due to pre-existing antibodies?
a) Acute rejection
b) Hyperacute rejection
c) Chronic rejection
d) Delayed rejection - Which of the following best describes acute rejection?
a) Caused by preformed antibodies
b) Occurs days to weeks post-transplant, mediated by T cells
c) Caused by chronic low-level antibody response
d) Occurs only in autografts - Chronic graft rejection is mainly characterized by:
a) Rapid necrosis of the graft
b) Antibody and T cell–mediated vascular damage and fibrosis
c) Preformed antibody reaction
d) Absence of inflammation - Which test is most important to prevent hyperacute rejection in kidney transplantation?
a) ABO blood group typing
b) Rh typing
c) ELISA for IgE
d) ANA testing - The most critical histocompatibility complex molecules in transplantation are:
a) HLA class I and II
b) ABO blood group antigens only
c) CD markers
d) TCR molecules - Which cytokine plays a major role in graft rejection by activating T cells?
a) IL-2
b) IL-4
c) IL-10
d) TNF-α - Which drug inhibits calcineurin and suppresses T cell activation?
a) Cyclosporine
b) Methotrexate
c) Cortisone
d) Azathioprine - Graft-versus-host disease (GVHD) is most common after:
a) Autograft
b) Allogeneic bone marrow transplant
c) Isograft
d) Xenograft - The primary immune mechanism of GVHD is:
a) Host antibodies destroying donor cells
b) Donor T cells attacking host tissues
c) Donor NK cells destroying graft tissue
d) Host neutrophils attacking donor cells - Which organ transplant has the lowest risk of rejection?
a) Kidney
b) Liver
c) Heart
d) Lung - Which immunosuppressive drug blocks IL-2 receptor signaling?
a) Tacrolimus
b) Sirolimus (Rapamycin)
c) Cyclophosphamide
d) Prednisone - Hyperacute graft rejection can be prevented by:
a) Cross-matching donor and recipient antibodies
b) Giving high-dose steroids after surgery
c) Suppressing T cells only
d) Using xenografts - Which type of rejection is primarily mediated by antibodies binding to donor endothelium?
a) Acute
b) Hyperacute
c) Chronic
d) None - A skin graft from a burn patient’s thigh to his arm is an example of:
a) Isograft
b) Xenograft
c) Allograft
d) Autograft - Which HLA molecules are most important for kidney transplantation matching?
a) HLA-A, HLA-B, HLA-DR
b) HLA-C, HLA-DQ, HLA-DP
c) ABO system only
d) HLA-E and HLA-F - Which immune suppression drug is an antimetabolite that interferes with DNA synthesis?
a) Azathioprine
b) Cyclosporine
c) Tacrolimus
d) Prednisone - Which is the major complication of bone marrow transplantation?
a) Graft rejection
b) Graft-versus-host disease
c) Hyperacute rejection
d) ABO incompatibility - The direct pathway of allorecognition occurs when:
a) Recipient T cells recognize intact donor HLA molecules
b) Recipient antibodies recognize donor proteins
c) Donor T cells attack host tissues
d) Cytokines block TCR activation - The indirect pathway of allorecognition occurs when:*
a) Donor T cells recognize host MHC
b) Recipient antigen-presenting cells process donor antigens and present them
c) NK cells destroy grafted tissue directly
d) Complement destroys donor cells - Which complement component is directly involved in hyperacute graft rejection?
a) C1q
b) C3b
c) C5a
d) C9 - Which type of transplant involves transfer of cells or tissues between genetically unrelated members of the same species?
a) Autograft
b) Allograft
c) Isograft
d) Xenograft - The earliest sign of acute rejection in kidney transplantation is usually:
a) Fever and graft tenderness
b) Fibrosis
c) Rapid necrosis within minutes
d) No symptoms - Which immunosuppressive drug binds FK506-binding protein and inhibits T cell activation?
a) Cyclosporine
b) Tacrolimus
c) Prednisone
d) Azathioprine - Which immune cell type is the main effector in chronic rejection?
a) CD8+ T cells and macrophages
b) Neutrophils
c) Eosinophils
d) Mast cells - Which graft is least likely to induce immune rejection?
a) Allograft
b) Autograft
c) Xenograft
d) Isograft - 1. A patient underwent renal transplant, receiving a kidney from an unrelated donor. This type of transplant is termed:
a) allograft
b) syngraft
c) autograft
d) xenograft - Which of the following is a hyperacute reaction that is not part of chronic cell-mediated transplant rejection?
a) narrowing and occlusion of graft blood vessels
b) reaction of T and B cells to graft antigen
c) antibodies to MHC antigens on white cells
d) arteriosclerosis of the graft arterial wall - Graft-versus-host disease is:
a) initiated by the recipient
b) a minor concern in bone marrow transplant
c) asymptomatic in most cases
d) initiated by the donor - Incompatibility by which of the following procedures is an absolute contraindication to allotransplantation?
a) MLC (mixed lymphocyte culture)
b) HLA typing
c) Rh typing
d) ABO grouping - Bone marrow transplant donors and their recipients should be preferentially matched for which antigen system(s)?
a) ABO-Rh
b) HLA
c) CD4/CD8
d) Pi²⁺ - A 28-year-old man is seen by a physician because of several months of intermittent low back pain. The patient’s symptoms are suggestive of ankylosing spondylitis. Which of the following laboratory studies would support this diagnosis?
a) a decreased synovial fluid CH50 level
b) low serum CH50 level
c) positive HLA-B27 antigen test
d) rheumatoid factor in the synovial fluid - HLA-B8 antigen has been associated with an increased incidence of which of the following pairs of diseases?
a) ankylosing spondylitis and myasthenia gravis
b) celiac disease and ankylosing spondylitis
c) myasthenia gravis and celiac disease
d) Reiter disease and multiple sclerosis - The process of centering the sample core within the sheath fluid in a flow cytometer is known as:
a) acoustic focusing
b) hydrodynamic focusing
c) liquid focusing
d) isoelectric focusing - The procedure for compatibility testing in organ transplant medicine is very similar for the donor and the recipient. One additional procedure that the recipient must undergo that is not relevant to donor testing is:
a) ABO typing
b) HLA typing
c) CMV testing
d) anti-HLA antibody testing - Which of the following best describes the role of Natural Killer (NK) cells in transplantation?
a) They are the primary initiators of graft-versus-host disease.
b) They recognize and kill cells lacking self MHC class I molecules.
c) They produce antibodies against donor HLA antigens.
d) They are not involved in the rejection process. - A patient receiving a bone marrow transplant from an HLA-identical sibling is at risk for graft-versus-host disease primarily because:
a) The recipient’s immune system is too weak to reject the graft.
b) Minor histocompatibility antigens differ between the donor and recipient.
c) ABO blood group incompatibility is always present.
d) The donor graft contains too many mature T cells. - Chronic rejection of a transplanted organ is characterized histologically by:
a) massive infiltration of neutrophils
b) vascular occlusion and fibrosis
c) deposition of immune complexes in glomeruli
d) hemorrhage and thrombosis - Which T-cell subset is most critical for mediating acute cellular rejection?
a) CD4+ T helper cells
b) CD8+ cytotoxic T cells
c) Regulatory T cells (Tregs)
d) Gamma-delta T cells - The mixed lymphocyte reaction (MLC) is used in transplantation to assess:
a) ABO blood group compatibility
b) The degree of HLA class I and class II disparity
c) Pre-existing antibodies in the recipient
d) The phagocytic function of donor neutrophils - Which immunosuppressive drug specifically inhibits the calcineurin pathway, preventing T-cell activation?
a) Azathioprine
b) Cyclosporine
c) Sirolimus (Rapamycin)
d) Mycophenolate mofetil - A positive crossmatch test before transplantation indicates:
a) A perfect HLA match between donor and recipient.
b) The presence of preformed antibodies in the recipient against donor antigens.
c) That the donor has been exposed to cytomegalovirus (CMV).
d) That the graft will be accepted without immunosuppression. - Which type of graft involves transferring tissue from one site to another on the same individual?
a) Allograft
b) Isograft (Syngraft)
c) Autograft
d) Xenograft - The most important function of regulatory T cells (Tregs) in transplantation is to:
a) Initiate the rejection response.
b) Promote the production of donor-specific antibodies.
c) Suppress immune responses and promote tolerance.
d) Activate macrophages to phagocytose donor cells. - Which of the following is a major limitation of using animal organs for transplantation into humans (xenotransplantation)?
a) The organs are too small for human recipients.
b) The risk of hyperacute rejection due to natural antibodies.
c) Human leukocyte antigens (HLA) cannot be matched.
d) Animal organs have a much shorter lifespan. - Plasmapheresis is sometimes used before transplantation to:
a) Increase the number of T cells in the recipient.
b) Remove preformed antibodies from the recipient’s circulation.
c) Stimulate the production of regulatory B cells.
d) Crossmatch the donor and recipient tissues. - The primary goal of using immunosuppressive drugs after transplantation is to:
a) Cure the recipient’s original disease.
b) Prevent and treat rejection by suppressing the immune system.
c) Stimulate the growth of the donor organ.
d) Increase the production of red blood cells. - Which of the following is a common complication of long-term immunosuppressive therapy?
a) Decreased risk of all infections
b) Increased risk of malignancies
c) Improved wound healing
d) Enhanced vaccine efficacy - Which test is crucial for monitoring the level of immunosuppression in patients taking tacrolimus or cyclosporine?
a) Complete blood count (CBC)
b) Serum creatinine
c) Trough drug levels in the blood
d) Liver function tests - A transplant recipient presents with fever and signs of organ dysfunction. A biopsy shows lymphocytic infiltration of the graft. This is most consistent with:
a) Hyperacute rejection
b) Acute cellular rejection
c) Chronic rejection
d) Graft-versus-host disease - Which immunoglobulin type is primarily involved in antibody-mediated rejection?
a) IgA
b) IgD
c) IgE
d) IgG - The direct pathway of allorecognition involves recipient T cells recognizing:
a) Recipient antigen-presenting cells (APCs) displaying self-peptides.
b) Donor-derived peptides presented by recipient APCs.
c) Intact donor MHC molecules on donor APCs.
d) Processed donor peptides presented by donor APCs. - Which cytokine plays a central role in activating T cells and is a target for immunosuppressive drugs?
a) Interleukin-2 (IL-2)
b) Interleukin-4 (IL-4)
c) Interleukin-10 (IL-10)
d) Interferon-gamma (IFN-γ) - What is the primary clinical use of the drug Basiliximab?
a) To treat viral infections post-transplant
b) As an induction agent to prevent acute rejection by blocking IL-2 receptors
c) To reduce cholesterol levels
d) To stimulate white blood cell production - A patient who received a liver transplant 10 years ago now shows gradual loss of organ function and biopsy reveals fibrous scarring. This is most indicative of:
a) Successful graft acceptance
b) Acute antibody-mediated rejection
c) Chronic rejection
d) An infectious complication - The success of a transplant is most dependent on:
a) The age of the donor
b) The color of the donor organ
c) The degree of histocompatibility between donor and recipient
d) The blood type of the transplant surgeon - 31. Which type of rejection is most effectively reduced by HLA matching?
a) Hyperacute rejection
b) Acute rejection
c) Chronic rejection
d) GVHD - Which immunoglobulin is most responsible for hyperacute graft rejection?
a) IgA
b) IgM
c) IgE
d) IgD - Which graft type has the highest risk of immunologic rejection?
a) Autograft
b) Isograft
c) Xenograft
d) Allograft - Which organ transplant is considered the most immunogenic?
a) Kidney
b) Heart
c) Skin
d) Liver - Which cytokine is central in promoting T cell proliferation during graft rejection?
a) IL-1
b) IL-2
c) IL-6
d) IFN-γ - Which cells initiate the indirect pathway of allorecognition?
a) Donor T cells
b) Recipient antigen-presenting cells
c) NK cells
d) Mast cells - Which immunosuppressive drug is commonly used in combination with calcineurin inhibitors to prevent graft rejection?
a) Azathioprine
b) Sirolimus (Rapamycin)
c) Methotrexate
d) Rituximab - Which type of graft rejection is most difficult to prevent with immunosuppressive therapy?
a) Hyperacute
b) Acute
c) Chronic
d) GVHD - In bone marrow transplantation, the main risk of immunologic complication is:
a) Rejection of donor marrow
b) Graft-versus-host disease
c) Chronic fibrosis
d) ABO incompatibility - Which organ is most resistant to rejection?
a) Kidney
b) Liver
c) Skin
d) Heart - The “mixed lymphocyte reaction” is used to evaluate:
a) Antibody levels
b) Histocompatibility between donor and recipient
c) Complement activity
d) Cross-matching of ABO blood groups - Which type of T cell plays the central role in graft rejection?
a) CD4+ helper T cells
b) CD8+ cytotoxic T cells
c) Regulatory T cells
d) NK T cells - Which complement pathway is most involved in hyperacute rejection?
a) Classical pathway
b) Alternative pathway
c) Lectin pathway
d) Terminal pathway only - Which therapy helps prevent graft rejection by depleting T cells before transplantation?
a) Anti-thymocyte globulin (ATG)
b) Prednisone
c) Cyclophosphamide
d) Rituximab - Which marker is most important to match for bone marrow transplantation?
a) HLA-A
b) HLA-B
c) HLA-DR
d) HLA-C - Which immune cells are directly cytotoxic to graft tissue during rejection?
a) CD8+ T cells
b) B cells
c) Mast cells
d) Plasma cells - Which organ transplant is most likely to require ABO compatibility in addition to HLA matching?
a) Kidney
b) Liver
c) Heart
d) Bone marrow - Which is the hallmark of graft-versus-host disease?
a) Donor antibodies against host cells
b) Donor T cells attack host tissues
c) Host NK cells destroy donor marrow
d) Complement overactivation - Which cytokine is strongly associated with graft rejection–related inflammation?
a) IL-4
b) TNF-α
c) IL-5
d) IL-10 - Which condition is an example of beneficial graft-versus-host effect?
a) Rejection of donor kidney
b) Donor marrow eliminating leukemia cells
c) Host immune system destroying donor liver
d) Skin graft acceptance - 1. Which of the following best defines an isograft?
a) A graft between genetically identical twins
b) A graft from one species to another
c) A graft from one site to another on the same individual
d) A graft between two unrelated individuals - The primary function of the major histocompatibility complex (MHC) in transplantation is to:
a) Act as the main target for immunosuppressive drugs
b) Present antigenic peptides to T cells, leading to recognition of foreign tissue
c) Produce antibodies that protect the graft from infection
d) Stimulate the production of red blood cells post-transplant - Which cell type is primarily responsible for the direct recognition of donor MHC molecules in acute rejection?
a) B cells
b) Neutrophils
c) T cells
d) Natural killer (NK) cells - What is the primary mechanism of action of Mycophenolate Mofetil?
a) It inhibits purine synthesis, selectively suppressing lymphocyte proliferation
b) It blocks the IL-2 receptor on activated T cells
c) It inhibits calcineurin, preventing T-cell activation
d) It binds to mTOR, inhibiting T-cell proliferation - A patient develops hyperacute rejection of a kidney graft within minutes of vascular anastomosis. This is most likely due to:
a) A mismatch in minor histocompatibility antigens
b) Pre-existing cytotoxic T cells in the recipient
c) Pre-formed antibodies against donor ABO or HLA antigens
d) An overwhelming bacterial infection - Which of the following is a key characteristic of chronic allograft rejection?
a) It occurs within hours of transplantation
b) It is primarily mediated by neutrophils and complement
c) It involves progressive fibrosis and narrowing of blood vessels
d) It is easily reversible with a short course of steroids - The main purpose of performing a “crossmatch” test before transplantation is to:
a) Determine the blood type of the donor
b) Detect pre-existing antibodies in the recipient that are specific to the donor’s lymphocytes
c) Assess the functional capacity of the donor organ
d) Measure the number of HLA antigens on the donor’s cells - Which immunosuppressive agent is a monoclonal antibody that targets the CD25 subunit of the IL-2 receptor?
a) Tacrolimus
b) Basiliximab
c) Azathioprine
d) Sirolimus - What is the most significant risk factor for developing post-transplant lymphoproliferative disorder (PTLD)?
a) Hypertension
b) Epstein-Barr virus (EBV) infection
c) Diabetes mellitus
d) Hyperlipidemia - In the context of bone marrow transplantation, what is the desired outcome of the graft-versus-leukemia (GVL) effect?
a) To cause graft-versus-host disease (GVHD)
b) To reject the donor bone marrow
c) To suppress the recipient’s immune system further
d) To eliminate residual cancer cells in the recipient - Which of the following is a common and serious complication of graft-versus-host disease (GVHD)?
a) Improved skin integrity
b) Damage to the liver, skin, and gastrointestinal tract
c) Enhanced immune function against pathogens
d) Increased production of red blood cells - What is the primary use of Antithymocyte Globulin (ATG) in transplantation?
a) As a long-term maintenance immunosuppressant
b) As an induction therapy to deplete T cells and prevent acute rejection
c) To treat viral infections like CMV
d) To stimulate bone marrow production - The indirect pathway of allorecognition involves recipient T cells recognizing:
a) Intact donor MHC molecules on donor cells
b) Donor-derived peptides presented by recipient antigen-presenting cells (APCs)
c) Recipient peptides presented by donor APCs
d) Bacterial peptides on donor tissue - Which of the following is a critical function of HLA matching in solid organ transplantation?
a) It guarantees the graft will never be rejected
b) It eliminates the need for any immunosuppressive drugs
c) It reduces the risk and severity of rejection episodes7
d) It prevents all viral infections post-transplant - What is a major advantage of using a living donor for kidney transplantation compared to a deceased donor?
a) Living donors do not require any HLA matching
b) Organs from living donors typically have better long-term function
c) The surgery is less complex for the recipient
d) It completely eliminates the risk of graft-versus-host disease - Which test is considered the “gold standard” for monitoring patients for rejection after heart transplantation?
a) Serial blood tests for HLA antibodies
b) Endomyocardial biopsy
c) Echocardiogram alone
d) Measurement of serum creatinine levels - The drug Sirolimus (Rapamycin) inhibits rejection by which mechanism?
a) Inhibiting calcineurin
b) Blocking purine synthesis
c) Binding to mTOR and inhibiting T-cell proliferation
d) Depleting circulating T cells - Which type of graft is most susceptible to hyperacute rejection?
a) Autograft
b) Isograft
c) Allograft
d) Xenograft - The primary goal of using corticosteroid drugs like Prednisone in transplant regimens is to:
a) Provide broad anti-inflammatory and immunosuppressive effects
b) Specifically target B-cell production of antibodies
c) Stimulate the production of regulatory T cells
d) Prevent bacterial infections - What does the term “host-versus-graft” (HVG) response refer to?
a) The donor immune cells attacking the recipient’s body
b) The recipient’s immune system attacking and rejecting the transplanted organ
c) A mutual acceptance between donor and recipient cells
d) The process of matching donor and recipient tissues
📌 How to Use This Mock Test
- Attempt the questions in exam conditions (timed, no reference materials).
- Review your answers against the answer key at the end.
- Note weak areas for targeted study and revision.
Answer Key
Answer Key:
- c) Isograft
- b) Xenograft
- b) Autograft
- b) Allograft
- b) T lymphocytes
- b) Hyperacute rejection
- b) Occurs days to weeks post-transplant, mediated by T cells
- b) Antibody and T cell–mediated vascular damage and fibrosis
- a) ABO blood group typing
- a) HLA class I and II
- a) IL-2
- a) Cyclosporine
- b) Allogeneic bone marrow transplant
- b) Donor T cells attacking host tissues
- b) Liver
- b) Sirolimus (Rapamycin)
- a) Cross-matching donor and recipient antibodies
- b) Hyperacute
- d) Autograft
- a) HLA-A, HLA-B, HLA-DR
- a) Azathioprine
- b) Graft-versus-host disease
- a) Recipient T cells recognize intact donor HLA molecules
- b) Recipient antigen-presenting cells process donor antigens and present them
- b) C3b
- b) Allograft
- a) Fever and graft tenderness
- b) Tacrolimus
- a) CD8+ T cells and macrophages
- b) Autograft
- a) allograft
- c) antibodies to MHC antigens on white cells
- d) initiated by the donor
- d) ABO grouping
- b) HLA
- c) positive HLA-B27 antigen test
- c) myasthenia gravis and celiac disease
- b) hydrodynamic focusing
- d) anti-HLA antibody testing
- b) They recognize and kill cells lacking self MHC class I molecules.
- b) Minor histocompatibility antigens differ between the donor and recipient.
- b) vascular occlusion and fibrosis
- b) CD8+ cytotoxic T cells
- b) The degree of HLA class I and class II disparity
- b) Cyclosporine
- b) The presence of preformed antibodies in the recipient against donor antigens.
- c) Autograft
- c) Suppress immune responses and promote tolerance.
- b) The risk of hyperacute rejection due to natural antibodies.
- b) Remove preformed antibodies from the recipient’s circulation.
- b) Prevent and treat rejection by suppressing the immune system
- b) Increased risk of malignancies
- c) Trough drug levels in the blood
- b) Acute cellular rejection
- d) IgG
- c) Intact donor MHC molecules on donor APCs.
- a) Interleukin-2 (IL-2)
- b) As an induction agent to prevent acute rejection by blocking IL-2 receptors
- c) Chronic rejection
- c) The degree of histocompatibility between donor and recipient
- b) Acute rejection
- b) IgM
- c) Xenograft
- c) Skin
- b) IL-2
- b) Recipient antigen-presenting cells
- b) Sirolimus (Rapamycin)
- c) Chronic
- b) Graft-versus-host disease
- b) Liver
- b) Histocompatibility between donor and recipient
- b) CD8+ cytotoxic T cells
- a) Classical pathway
- a) Anti-thymocyte globulin (ATG)
- c) HLA-DR
- a) CD8+ T cells
- d) Bone marrow
- b) Donor T cells attack host tissues
- b) TNF-α
- b) Donor marrow eliminating leukemia cells
- a) A graft between genetically identical twins
- b) Present antigenic peptides to T cells, leading to recognition of foreign tissue
- c) T cells
- a) It inhibits purine synthesis, selectively suppressing lymphocyte proliferation
- c) Pre-formed antibodies against donor ABO or HLA antigens
- c) It involves progressive fibrosis and narrowing of blood vessels
- b) Detect pre-existing antibodies in the recipient that are specific to the donor’s lymphocytes
- b) Basiliximab
- b) Epstein-Barr virus (EBV) infection
- d) To eliminate residual cancer cells in the recipient
- b) Damage to the liver, skin, and gastrointestinal tract
- b) As an induction therapy to deplete T cells and prevent acute rejection
- b) Donor-derived peptides presented by recipient antigen-presenting cells (APCs)
- c) It reduces the risk and severity of rejection episodes
- b) Organs from living donors typically have better long-term function
- b) Endomyocardial biopsy
- c) Binding to mTOR and inhibiting T-cell proliferation
- d) Xenograft
- a) Provide broad anti-inflammatory and immunosuppressive effects
- b) The recipient’s immune system attacking and rejecting the transplanted organ
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