Transplant Surgery
Core concepts
Understand the principles of organ donation, brain death determination, and allocation systems. Know the immunology of transplant rejection: hyperacute, acute cellular, antibody-mediated, and chronic. Master immunosuppression classes (calcineurin inhibitors, antimetabolites, steroids, induction agents) and their complications. Understand the evaluation of the transplant candidate, donor-recipient matching, and the surgical principles of kidney, liver, heart, and lung transplantation. Know the presentation and management of graft dysfunction and infection in the immunosuppressed patient.
Traps in questions
Questions often test the timing of rejection: hyperacute occurs minutes to hours, acute cellular occurs days to months, and chronic occurs over months to years. Distinguish drug toxicity from rejection; both can cause graft dysfunction. Another trap is confusing cytomegalovirus disease with rejection. Watch for questions about prophylaxis and vaccination in transplant candidates.
Worked rule of thumb
When a transplant patient develops fever or graft dysfunction, consider infection and rejection together. Biopsy is often needed; do not assume rejection without tissue diagnosis when infection is possible.
Exam strategy
Link immunosuppression to infection risk and malignancy risk. The more potent the regimen, the broader the opportunistic infection differential.