American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following medications is used for immunosuppression in liver transplant recipients?

1. Azathioprine

2. Prednisone

3. Tacrolimus

4. Methotrexate

The correct answer is: Tacrolimus

Tacrolimus is a medication that is widely used for immunosuppression in liver transplant recipients. As a calcineurin inhibitor, it works by suppressing the immune response to prevent the body from rejecting the newly transplanted liver. After liver transplantation, it is crucial to maintain an effective level of immunosuppression to reduce the risk of acute rejection while allowing enough immune function to fight infections. Tacrolimus is often preferred due to its potent immunosuppressive effects and better side effect profile compared to other drugs. It predominantly inhibits T-cell activation and proliferation, which plays a central role in the body's rejection response. In clinical practice, tacrolimus is frequently used in combination with other immunosuppressants such as steroids to enhance the overall effectiveness of the immunosuppressive regimen. While azathioprine and prednisone are also used in managing transplant patients, azathioprine is not commonly a first-line agent anymore due to its side effects and the emergence of more effective therapies. Prednisone is typically used as a part of an induction or maintenance regimen but is not the primary immunosuppressive agent on its own. Methotrexate is generally used for certain autoimmune conditions and specific malignancies rather than as a standard immun