American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which treatment options can be used for desensitization in incompatible transplants?

1. Antithymocyte globulin

2. Sirolimus and rituximab

3. Plasmapheresis and IVIG

4. Corticosteroids

The correct answer is: Plasmapheresis and IVIG

Desensitization in incompatible transplants is a critical process aimed at minimizing the risk of hyperacute rejection and facilitating successful graft acceptance in patients who have existing antibodies against donor antigens. Among the options provided, the combination of plasmapheresis and intravenous immunoglobulin (IVIG) is established as an effective method to achieve desensitization. Plasmapheresis works by removing circulating antibodies from the patient's blood, lowering the overall level of sensitization against the donor antigens. This process can reduce the risk of immediate graft rejection. IVIG complements this by providing a pooled source of immunoglobulin, which helps modulate the immune response. The use of IVIG can further inhibit antibody production and provide high levels of normal immunoglobulins, which may also compete with the offending antibodies and provide anti-inflammatory effects. The other options mentioned may play roles in transplant management or in immunosuppression but are not specifically aimed at desensitization. Antithymocyte globulin is primarily used for induction immunosuppression or treatment of acute rejection. Sirolimus and rituximab can be utilized in managing immunological responses in specific contexts, but their roles in desensitization are not as direct or established as