Thursday, December 29, 2011

Transplant Immunosuppression on Step 1

Like any workaholic second-year medical student, I'm spending part of the holiday break studying for Step 1 of the boards (the standardized Big Test after the first two years of medical school).  But since it is supposed to be a vacation, I felt justified in studying a more familiar topic, so transplant immunosuppression it is.

Wow.  Everyone says that the textbooks and the exams are ten years behind the times, but it's really striking in a field that changes as fast as transplantation.  Also, the testable facts are based on FDA labeling and the approved indications, which are quite a bit more limited than clinical practice, especially for transplants that are done less commonly.  So, what I've "learned" is:

  • Cyclosporine, azathioprine, and OKT3 are commonly used immunosuppressants.
  • Cyclosporine is used for kidney, liver, and heart transplants; tacrolimus is used for kidney and liver transplants; everything else is used for kidney transplants lung transplants must not need any immunosuppression at all!
  • Daclizumab (Zenapax) is used as an antibody against the IL-2 receptor, even though it's no longer manufactured in the US since Simulect (basiliximab) is now preferred.
  • Thymoglobulin, Campath (alemtuzumab), and belatacept don't exist (or rather, knowing them won't help me one bit on the test :-/).
Anyway, pretty obvious defense mechanisms in play with this post!  There's more to worry about than the anachronisms in the transplant immunosuppression section, like how much else there is to study, how out of date it may be (without me knowing it), and how much I'll have to unlearn or get a clue about before actually being able to take care of patients.