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 only...so 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 :-/).