Transplant

Question 1

What are the goals of immunosuppressive therapy in SOT?

Answer 1

Prevent rejection while minimizing drug toxicity, infection risk, and malignancy.

Question 2

What is the difference between induction and maintenance immunosuppression?

Answer 2

Induction is short-term and used peri-transplant to prevent acute rejection. Maintenance is lifelong to prevent chronic rejection.

Question 3

What are examples of lymphocyte-depleting induction agents?

Answer 3

Thymoglobulin (rabbit ATG), Alemtuzumab.

Question 4

What is a non-lymphocyte depleting induction agent?

Answer 4

Basiliximab.

Question 5

Which induction agent is contraindicated in patients with high infection risk or prior malignancy?

Answer 5

Lymphocyte-depleting agents (e.g., alemtuzumab, thymoglobulin).

Question 6

What is the mechanism of action of calcineurin inhibitors?

Answer 6

Inhibit calcineurin, blocking T-cell activation (signal 1).

Question 7

Name two calcineurin inhibitors used in SOT.

Answer 7

Cyclosporine and tacrolimus.

Question 8

What are key adverse effects of tacrolimus?

Answer 8

Nephrotoxicity, neurotoxicity, hyperglycemia, electrolyte disturbances, alopecia.

Question 9

What is the mechanism of action of mycophenolate?

Answer 9

Inhibits de novo purine synthesis in lymphocytes.

Question 10

What are common side effects of mycophenolate?

Answer 10

GI toxicity, leukopenia, teratogenicity.

Question 11

What is the mechanism of action of mTOR inhibitors?

Answer 11

Bind FKBP12 to inhibit mTOR, blocking T-cell proliferation (signal 3).

Question 12

What are two mTOR inhibitors used in transplant?

Answer 12

Sirolimus and everolimus.

Question 13

Why are mTOR inhibitors not used immediately post-transplant?

Answer 13

They impair wound healing.

Question 14

What is the mechanism of corticosteroids in SOT?

Answer 14

Inhibit cytokine transcription and T-cell signaling.

Question 15

List three common steroid side effects in SOT.

Answer 15

Hyperglycemia, hypertension, osteoporosis.

Question 16

What is the mechanism of action of belatacept?

Answer 16

Blocks co-stimulation by binding CD80/86 on APCs, preventing CD28 activation on T cells.

Question 17

What are key risks associated with belatacept?

Answer 17

PTLD, especially in EBV-seronegative patients; contraindicated in EBV-negative patients.

Question 18

What is first-line treatment for acute cellular rejection?

Answer 18

High-dose corticosteroids (e.g., methylprednisolone 500–1000 mg IV daily for 3–5 days).

Question 19

What agents are used for antibody-mediated rejection?

Answer 19

IVIG, rituximab, corticosteroids, and plasmapheresis.

Question 20

What drugs are used for PJP prophylaxis in SOT?

Answer 20

SMX/TMP, atovaquone, dapsone, or inhaled pentamidine.

Question 21

What agents are used for CMV prophylaxis?

Answer 21

Ganciclovir or valganciclovir.

Question 22

Which antifungal agents are used in SOT prophylaxis?

Answer 22

Fluconazole, posaconazole, voriconazole, nystatin, clotrimazole (depending on transplant type).

Question 23

What are the primary goals of pharmacotherapy in solid organ transplant (SOT)?

Answer 23

Prevent graft rejection, minimize toxicity, reduce infection and malignancy risk, and improve patient and graft survival.

Question 24

What are the key components of immunosuppressive regimens?

Answer 24

Induction therapy (short-term), maintenance therapy (lifelong), and treatment of rejection (pulse steroids or biologics).

Question 25

How do calcineurin inhibitors work in immunosuppression?

Answer 25

They inhibit calcineurin, preventing IL-2 transcription and T-cell activation (signal 1).

Question 26

What is the role of antimetabolites in transplant pharmacotherapy?

Answer 26

Inhibit lymphocyte proliferation by interfering with nucleotide synthesis.

Question 27

What is the mechanism of mTOR inhibitors in transplant therapy?

Answer 27

Block T-cell proliferation by inhibiting the mTOR pathway (signal 3).

Question 28

What are the risks associated with using belatacept?

Answer 28

Post-transplant lymphoproliferative disorder (PTLD), especially in EBV-seronegative patients.

Question 29

What are first-line therapies for acute cellular rejection in SOT?

Answer 29

High-dose corticosteroids, followed by lymphocyte-depleting agents if steroid-resistant.

Question 30

What infections should SOT patients be prophylaxed against?

Answer 30

Pneumocystis jirovecii (PJP), cytomegalovirus (CMV), fungal infections.

Question 31

What levels should be monitored for tacrolimus?

Answer 31

Trough levels; typical range 5–15 ng/mL depending on transplant type and time post-transplant.

Question 32

What are key adverse effects of tacrolimus?

Answer 32

Nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperkalemia, hypomagnesemia, alopecia.

Question 33

What levels should be monitored for cyclosporine?

Answer 33

Trough levels or 2-hour post-dose (C2) levels.

Question 34

What are key adverse effects of cyclosporine?

Answer 34

Nephrotoxicity, hypertension, hirsutism, gingival hyperplasia, hyperlipidemia.

Question 35

What lab monitoring is required with sirolimus or everolimus?

Answer 35

Trough drug levels (e.g., 5–15 ng/mL), lipid panels, CBC (for leukopenia/thrombocytopenia), and renal function.

Question 36

What are adverse effects of mTOR inhibitors?

Answer 36

Impaired wound healing, hyperlipidemia, mouth ulcers, proteinuria, cytopenias.

Question 37

What labs should be monitored with mycophenolate?

Answer 37

CBC (for leukopenia), GI symptoms, and pregnancy testing due to teratogenicity.

Question 38

What are common side effects of mycophenolate?

Answer 38

GI upset (diarrhea, nausea), leukopenia, anemia, teratogenicity.

Question 39

What should be monitored during long-term corticosteroid use?

Answer 39

Blood glucose, blood pressure, bone density, and signs of infection.

Question 40

What are long-term side effects of corticosteroids?

Answer 40

Hyperglycemia, osteoporosis, weight gain, mood changes, cataracts, hypertension.

Question 41

What is a key safety consideration before initiating belatacept?

Answer 41

Patient must be EBV-seropositive due to risk of post-transplant lymphoproliferative disorder (PTLD).

Question 42

What adverse effects are associated with belatacept?

Answer 42

PTLD, anemia, leukopenia, diarrhea, peripheral edema.