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Chapter 55. Solid Organ Transplantation

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A 38-year-old white man is scheduled to receive a living-unrelated renal transplant this week at your hospital. The donor is the patient’s 35-year-old brother-in-law, who is a 6-out-of-6 HLA mismatch. The patient’s underlying renal failure is presumed to be due to uncontrolled diabetes mellitus and hypertension. He has required hemodialysis for the past 3 months. His past medical history is significant for diabetes mellitus, obesity (95 kg), hypertension, hyperlipidemia, gout, depression, and hypothyroidism. He drinks alcohol socially and has a remote history of tobacco usage. He is a father of three and has been married for the past 12 years.

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Current medication list: levothyroxine 125 mcg once daily, allopurinol 100 mg once daily, simvastatin 20 mg once daily, amlodipine 5 mg once daily, metoprolol succinate 100 mg once daily, insulin glargine 24 units at bedtime, insulin aspart (sliding scale), and sertraline 50 mg once daily

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The patient is blood type-O. During the evaluation of his family members for a potential donor, the team told him that he required a donor with the same blood type. His brother-in-law was also a blood type-O. What type of rejection would the patient be at risk for if he received a renal transplant from a donor who wasn’t a blood type-O donor?

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A. Antibody-mediated rejection

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B. Acute rejection

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C. Hyperacute rejection

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D. Chronic rejection

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E. None of the above

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A 38-year-old white man is scheduled to receive a living-unrelated renal transplant this week at your hospital. The donor is the patient’s 35-year-old brother-in-law, who is a 6-out-of-6 HLA mismatch. The patient’s underlying renal failure is presumed to be due to uncontrolled diabetes mellitus and hypertension. He has required hemodialysis for the past 3 months. His past medical history is significant for diabetes mellitus, obesity (95 kg), hypertension, hyperlipidemia, gout, depression, and hypothyroidism. He drinks alcohol socially and has a remote history of tobacco usage. He is a father of three and has been married for the past 12 years.

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Current medication list: levothyroxine 125 mcg once daily, allopurinol 100 mg once daily, simvastatin 20 mg once daily, amlodipine 5 mg once daily, metoprolol succinate 100 mg once daily, insulin glargine 24 units at bedtime, insulin aspart (sliding scale), and sertraline 50 mg once daily

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The transplant surgeon on your team would prefer to use basiliximab as induction therapy due to its efficacy and superior tolerability. The team is aware that basiliximab is a monoclonal antibody but is unaware of how it exerts its effect on lymphocytes. What is the best description for basiliximab’s mechanism of action?

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A....

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