Immunosuppression — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementImmunosuppressionORE Part 1

A 50-year-old woman on long-term immunosuppressive therapy (azathioprine and prednisolone) for a renal transplant requires dental treatment. Which of the following is the most important consideration?

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Correct answer: C — Increased susceptibility to infection and potential adrenal suppression

The correct answer is C. Renal transplant patients on long-term immunosuppressive therapy face two critical dental management considerations: (1) Increased infection susceptibility due to both prednisolone and azathioprine suppressing cellular immunity, compounded by azathioprine-induced bone marrow suppression causing cytopenias; and (2) Adrenal axis suppression from long-term prednisolone, requiring stress-dose corticosteroid cover during dental procedures to prevent acute adrenal insufficiency. Option E is incorrect: gingival overgrowth is associated with cyclosporine, not azathioprine. Option D is implausible at stable maintenance prednisolone doses (5–10 mg daily). Option B is factually wrong: azathioprine does not cause tooth discolouration. Option A is not a characteristic side effect of either drug at therapeutic doses.

Reference: A Comprehensive Oral Preventive Care Protocol for Caring for the Renal Transplant Population. PubMed. 2016. https://pubmed.ncbi.nlm.nih.gov/27105787/