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

What condition often requires increased immunosuppression and steroids as treatment?

1. Acute rejection

2. Chronic rejection

3. Accelerated rejection

4. Humoral rejection

The correct answer is: Accelerated rejection

Accelerated rejection is characterized by a rapid immune response to transplanted tissue that occurs due to pre-existing antibodies or sensitization from prior transplants or pregnancies. In this condition, the recipient's immune system quickly mounts a vigorous attack against the transplanted organ, leading to significant tissue damage. The need for increased immunosuppression and steroids in the management of accelerated rejection arises from the swift and potent nature of the immune response involved. Standard immunosuppressive protocols may not be sufficient to quell this aggressive rejection, hence the necessity to intensify the immunosuppression treatment and incorporate higher doses of corticosteroids to quickly mitigate the inflammatory response. In contrast, acute rejection typically occurs days to weeks after transplantation and may respond to standard immunosuppression protocols. Chronic rejection develops over a long period and involves a slow, progressive loss of function that may require adjustments in therapy but does not demand immediate and intense modifications in treatment. Humoral rejection, while it does involve antibodies, is generally categorized separately from accelerated rejection and requires specific therapies targeting the antibody-mediated response rather than an immediate increase in general immunosuppressive therapy. Therefore, accelerated rejection is unique in its requirement for a more aggressive treatment approach due to the urgency and severity of the immune response.