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Question 4#

Concerning composite tissue allotransplantation, which of the following is true?

a. Corticosteroids are used for both maintenance therapy and treatment of acute rejection episodes and act by inhibiting NF-kB activation and inflammatory cytokine production
b. Antithymocyte globulin (ATG) is an induction agent which binds cell surface antigens, and depletes T cells
c. Tacrolimus (FK 506) blocks the production of IL-2 and has been shown in recent studies to possibly speed up nerve regrowth
d. Mycophenolate mofetil (MMF) prevents T-cell proliferation and differentiation
e. All of the above

Correct Answer is E

Comment:

All of the above. The ultimate goal, and thus the focus of transplant immunology research, is to effectively suppress rejection while minimising toxic side effects. In clinical practice this is achieved through a balance of multiple drugs that interfere with the immune response at various sites by blocking the formation, stimulation, proliferation, and differentiation of lymphocytes. These drugs are administered immediately after transplanting the organ or tissues (induction therapy) and regularly thereafter ‘for life’ (maintenance therapy) and in response to rejection episodes (treatment or rescue therapy). The above drugs are often used following composite tissue allotransplantation. 

References:
1. Whitaker IS, Duggan EM, Alloway RR, Brown CS, McGuire S, Woodle ES, Hsiao EC, Maldonado C, Banis JC, Jr., Barker JH. Composite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons. J Plast Reconstr Aesthet Surg 2008; 61(5): 481-92.