Lung Transplant Immunosuppression — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaLung Transplant ImmunosuppressionFRCA Final

A 58-year-old man undergoes a lung transplant. He is in the ICU post-operatively on ventilation. Which immunosuppressive regime is typically commenced immediately?

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Correct answer: D — Rituximab only

Standard lung transplant immunosuppression comprises triple therapy: a calcineurin inhibitor (tacrolimus or ciclosporin), an antimetabolite (mycophenolate mofetil or azathioprine), and corticosteroids. Induction therapy with basiliximab (IL-2 receptor antibody) or anti-thymocyte globulin is also commonly used perioperatively. The anaesthetic and ICU implications include increased infection risk, drug interactions (tacrolimus with volatile agents, ciclosporin with muscle relaxants), and renal toxicity monitoring.

Reference: NICE – 2019 – Organ transplant immunosuppression; RCOA – 2023 – Cardiothoracic/transplant module