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

Which immunosuppression agent is linked to poor wound healing?

1. FK506 (tacrolimus)

2. Sirolimus (rapamycin)

3. Azathioprine

4. Mycophenolate mofetil

The correct answer is: Sirolimus (rapamycin)

Sirolimus, also known as rapamycin, is an immunosuppressive agent that has been specifically associated with delayed wound healing. Its mechanism of action involves inhibiting mTOR (mechanistic target of rapamycin), which plays a crucial role in cell proliferation, survival, and metabolism. The disruption of these processes can affect not only the immune response but also cellular mechanisms important for tissue repair and regeneration, thus contributing to poor wound healing outcomes. In the context of surgical procedures, this characteristic can be particularly concerning, as adequate wound healing is vital to prevent complications like infections and dehiscence. Therefore, in patients receiving sirolimus, surgeons may need to monitor wound healing more closely and consider alternative strategies if necessary to enhance recovery. The other immunosuppressive agents mentioned have different mechanisms and effects. For example, tacrolimus primarily inhibits T-cell activation but has a relatively less pronounced impact on wound healing compared to sirolimus. Azathioprine and mycophenolate mofetil also affect immune response but are less directly implicated in impaired wound healing than sirolimus.