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Chapter 55. Solid Organ Transplantation

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.

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

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?

A. Antibody-mediated rejection

B. Acute rejection

C. Hyperacute rejection

D. Chronic rejection

E. None of the above

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.

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

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?

A....

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