Solid Organ Transplantation Pharmacy Specialty Review Course and Practice Exam (No Recert Credit) (Cert # L249203)

These activities are intended for pharmacists who are seeking to update their knowledge and skills commensurate with a board certification examination in the areas listed below.

This course consists of 19 activities (see table below) and provides up to 23.5 contact hours of continuing pharmacy education credit. The Review Course includes case-based presentations for application to real-life scenarios, a practice exam along with correct answers, and links to the reference sources, and domains, tasks, and knowledge statements. To help you further prepare, this package includes a compilation of practice questions in the same format and rigor to help you prepare for the BPS Specialty Examination.

After participating in this CPE activity, learners should be able to: 

ACPE Number: 0217-9999-24-165-H01-P

Transplant Immunology

• Differentiate between components of innate and adaptive immunity.
• Review lymphocyte activation, differentiation and effect mechanisms.
• Discuss pathways of allorecognition, transplant rejection and injury.
• Assess immunologic risk of rejection.
• Describe pathways to immunologic tolerance of allograft. 

Induction and Management of Acute Cellular Rejection

• Outline the principles of induction immunosuppression and how these agents can be used for different organs.
• Compare and contrast the available induction agents; specifically focusing on mechanism of action, ease of administration, adverse events and economic impact.
• Evaluate the efficacy of induction therapy among the different organs.
• Design an evidence-based induction regimen centered on donor, recipient and transplant characteristics.
• Compare and contrast the agents available for the treatment of acute cellular rejection.
• Assess the optimal therapeutic options for management of acute cellular rejection.

ACPE Number: 0217-9999-24-166-H01-P

Maintenance of Immunosuppression Part One

• Differentiate between the pharmacokinetic profiles of immunosuppressive medication formulations utilized in solid organ transplantation.
• Select the appropriate method for therapeutic drug monitoring of immunosuppressive medications.
• Design an initial immunosuppression regimen for a solid organ transplant recipient utilizing a patient’s pharmacogenomic data.
• Revise an immunosuppression regimen for a solid organ transplant recipient based on the presence of pertinent drug-drug interactions.
• Assess patient-specific data to identify immunosuppression-related adverse effects.
• Design an appropriate monitoring plan for immunosuppressive medications. 

Approaches to Prevent and Manage Antibody Development

• Supplementary material only

ACPE Number: 0217-9999-24-167-H01-P

Kidney Transplantation

• Evaluate effects of nonadherence on long-term allograft survival.
• Assess non-pharmacologic and pharmacologic risks of patients undergoing kidney transplant evaluation.
• Distinguish between absolute and relative contraindications to kidney transplant.
• Differentiate pathophysiology of and design management strategies for allograft specific complications.
• Design modifications to therapy that account for patient-specific factors, immunologic risk, and complications after kidney transplant.
• Assess barriers after kidney transplant and implement strategies to improve adherence. 

Liver Transplantation

• Describe diagnoses that may lead to referral for liver transplantation.
• Identify indications and contraindications for liver transplantation.
• Create a medication regimen for a liver transplant recipient taking into account immunologic risks and comorbid conditions.
• Summarize the presentation and management of common immunologic and non-immunologic complications after liver transplantation.
• Evaluate potential causes of medication non-adherence after liver transplantation. 

Pancreas and Islet Cell Transplantation and Intestinal Transplantation
Pancreas and Islet Cell Transplantation

• Demonstrate an understanding for common complications of pancreas transplantation and develop strategies to prevent or treat these complications.
• Devise a monitoring strategy to evaluate exocrine and endocrine function after pancreas transplantation.
• Compare and contrast the advantages and disadvantages of pancreas and islet cell transplantation. 

Intestinal Transplantion

• Describe the etiologies of intestinal transplantation.
• List the current trends in immunosuppression for small bowel transplantation.
• Discuss the common complications observed after small bowel transplantation. 

Vascularized Composite Allotransplantation

• Supplementary material only

ACPE Number: 0217-9999-24-168-H01-P

Heart Transplantation

• Describe common indications that may lead to heart transplantation.
• Identify pre-transplant risk factors that may impact outcomes after heart transplantation.
• Describe heart techniques for rejection surveillance.
• Understand heart specific pathologic findings.
• List and discuss heart specific post-transplant complications and strategies for management. 

Lung Transplantation

• Describe diagnoses that may lead to end-stage lung disease and referral for lung transplantation.
• Identify indications, absolute contraindications, and relative contraindications for lung transplantation.
• Formulate a medication regimen for a lung transplant recipient, taking into account immunologic risks and needs, preventative needs, and comorbid diseases.
• Explain the objective testing used to evaluate lung allograft function.
• Summarize the presentation and management of common immunologic complications after lung transplantation.
• Summarize the presentation and management of common non-immunologic complications after lung transplantation. 

Maintenance of Immunosuppression Part Two
Kidney

• Create an evidence-based maintenance regimen for a kidney transplant recipient that accounts for patient-specific factors.
• Evaluate the role of extended-release tacrolimus formulations and novel immunosuppression regimens. 

Liver

• Evaluate maintenance immunosuppression regimens for liver transplant recipients that account for patient-specific factors.
• Design evidence based maintenance immunosuppression regimens for liver transplant recipients.

Pancreas and Islet Cell

• Design a maintenance immunosuppression regimen for the prevention of rejection after pancreas transplant.
• Design a maintenance immunosuppression regimen for the prevention of rejection after islet cell transplant.

Heart

• Describe common immunosuppression approaches in heart transplantation.
• Discuss alternate approaches to immunosuppression.

Lung

• Compare and contrast the benefit, risk, and role of each maintenance immunosuppressant medication in lung transplantation.
• Design evidence-based maintenance immunosuppression regimens for lung transplant recipients.

ACPE Number: 0217-9999-24-169-H01-P

Infection Prevention and Management in Solid Organ Transplant Patients

• Develop appropriate pre-transplant serologic testing recommendations and interpretation of these results.
• Identify risk factors associated with post-transplant infections and the epidemiology and timing of these infections.
• Design strategies to prevent post-transplant opportunistic infections, including prophylaxis regimens and monitoring parameters.
• Formulate treatment plans for bacterial, viral, and fungal infections in solid-organ transplant recipients.
• Develop monitoring plans for patients receiving antimicrobials, complete with management of adverse effects and intolerances. 

Prevention and Management of Malignancy in Solid Organ Transplant Patient

• Demonstrate the common pathogenesis of and risk factors for types of malignancy after solid organ transplant.
• Distinguish between the types of malignancy that are of increased risk before and after solid organ transplant.
• Assess preventative strategies for malignancy after transplantation.
• Diagram an overview of immunosuppression management in the setting of malignancy.
• Compare common treatment approaches to common malignancies after transplantation, including non-melanoma skin cancer, post-transplant lymphoproliferative disorder, and Kaposi’s sarcoma.

ACPE Number: 0217-9999-24-170-H01-P

Primary Care of the Solid Organ Transplant Patient

• Apply general principles and practices of disease prevention to solid organ transplant recipients.
• Outline unique patient populations that require additional disease screening.
• Create an immunization plan for a solid organ transplant recipient in both the pre and post-transplant setting.
• Identify reputable resources for public education and awareness on organ transplantation including organ donation. 

Special Considerations in Pediatric and Geriatric Transplant Populations
Pediatrics

• Discuss practical differences of medication use in children with emphasis on pharmacokinetics, formulations, and monitoring of commonly used immunosuppressants.
• Describe the etiologic differences for organ disease and discuss associated complications after solid organ transplant in children.
• Design a pharmacotherapeutic treatment plan for pediatric patients undergoing intended ABO incompatible organ transplantation.
• Formulate an immunization plan for a pediatric organ transplant candidate.

Geriatrics

• Compare outcomes of transplant recipients by age group.
• Evaluate geriatric candidates for transplant based on guideline recommendations.
• Distinguish pharmacokinetic differences among geriatric transplant recipients.
• Design an immunosuppression regimen for a geriatric transplant recipient.

ACPE Number: 0217-9999-24-171-H99-P

Trial Design and Biostatistics

• Describe hypothesis testing and state the meaning of and distinguish between p values, confidence intervals, and measures of central tendency and data spread.
• Define, compare, and contrast the concepts of internal and external validity, causation, association, bias, and confounding in trial design. Select strategies to eliminate or control for covariates that may impact study conclusions.
• Compare and contrast the advantages and disadvantages of various study designs (e.g., prospective, retrospective, case-control, cohort, cross-sectional, randomized controlled clinical trials, systematic review, meta-analysis).
• Determine why a statistical test is appropriate or not appropriate, given the sample distribution, data type, and study design. Interpret statistical and clinical significance for results from commonly used statistical tests.
• Define and evaluate odds ratio, risk/incidence rate, relative risk, number needed to treat, number needed to harm, and other risk estimates.

ACPE Number: 0217-9999-24-172-H99-P

Continuity of Care and Managing Transitions of Care in the Transplant Patient

• Describe the role of the pharmacist in obtaining an accurate medication, allergy and immunization history and the importance of proper medication reconciliation in solid organ transplant recipients at all stages of the transplant process.
• Identify challenges in assessing readiness of a pediatric patient to transition to the adult transplant care team.
• Examine the unique role of a pharmacist in the transition of solid organ transplant recipients between healthcare settings as it relates to medication error reduction, cost avoidance, and hospital readmission.
• Summarize the common obstacles and potential solutions to proper medication adherence post-transplant including health literacy, cultural competence and language and sensory barriers.
• Identify common barriers to medication access in solid organ transplant recipients and compare the various medication access resources available. 

Transplant Regulations and Performance Improvement

• Review regulations for solid organ transplantation (SOT) programs.
• Highlight regulations that may involve SOT pharmacists.
• Discuss strategies to develop policies and procedures for SOT pharmacists that are consistent with transplant regulatory requirements.
• Identify opportunities for SOT pharmacists to participate in Quality Assessment and Performance Improvement (QAPI) activities to enhance the safety and effectiveness of medication-use process in SOT.
• Evaluate compliance with institutional guidelines in order to identify outcomes, adverse events and areas failing to meet expectations and implement performance improvement initiatives.
• Diagram involvement of SOT pharmacists in collaborative relationships with interdisciplinary transplant team to promote quality patient care across the continuum. 

Transplant Resources, Patient Education and Transplant Study Endpoints

• List key government organizations and transplant societies that influence the practice of solid organ transplantation.
• Compare practice-defining guidelines within the field of solid organ transplantation.
• Assess patients’ barriers to understanding their medication regimen and adapt education strategy to foster patient competency.
• Describe appropriate monitoring strategies for transplant medications requiring REMS participation.
• Formulate an appropriate contraceptive regimen for a female transplant recipient of childbearing age.
• Evaluate patient risk factors for non-adherence and implement a plan to improve compliance.
• Review transplant study end points used in the literature to establish efficacy of clinical intervention.

Kari Allan, PharmD, BCPS, BCPPS
Clinical Pharmacist Specialist, Solid Organ Transplant
Department of Pharmacy
Children’s Hospital Colorado
Aurora, Colorado 

Nicole R. Alvey, PharmD, FAST, BCTXP
Associate Professor of Clinical Sciences
Roosevelt University College of Science, Health, and Pharmacy
Clinical Pharmacy Specialist, Solid Organ Transplant
Rush University Medical Center
Chicago, Illinois

Sarah E. Bova, PharmD, BCPS, BCTXP
Solid Organ Transplant Clinical Pharmacy Specialist
University of Maryland Medical Center
Baltimore, Maryland 

Maya Campara, PharmD, FCCP, FAST, BCTXP*
Clinical Associate Professor, Pharmacy Practice and Surgery
University of Illinois at Chicago
Chicago, Illinois 

Jillian P. Casale, PharmD, BCPS, BCTXP
Senior Transplant Pharmacist
Cooperman Barnabas Medical Center
Livingston, New Jersey 

Steven Gabardi, PharmD, FCCP, FAST, BCPS*
Director of Continuing Education
TG Medical Education
Wilmington, Massachusetts 

Jennifer C. Hagopian, PharmD, BCPS, BCTXP
Clinical Pharmacist Specialist, Solid Organ Transplant
Michigan Medicine
Ann Arbor, Michigan 

Kimberly Harrison, PharmD, BCPS, BCTXP
Cardiothoracic Transplant Clinical Specialist
Vanderbilt University Medical Center
Nashville, Tennessee 

Tiffany E. Kaiser, PharmD, MS, FCCP, AF-AASLD
Transplant Clinical Pharmacist
Director, Solid Organ Transplant Quality
University of Cincinnati
Cincinnati, Ohio 

Clare Kane, PharmD, BCTXP
Clinical Pharmacist, Solid Organ Transplant
Northwestern Memorial Hospital
Chicago, Illinois 

Robin Klasek, PharmD, BCPS (Supplementary material)
Medical Science Liaison
Takeda Pharmaceuticals
Boston, Massachusetts 

Hanna L. Kleiboeker, PharmD, BCTXP
Clinical Pharmacist, Solid Organ Transplant
Northwestern Memorial Hospital
Chicago, Illinois 

Angela Maldonado, PharmD, FCCP, FAST, BCPS, CPP (Supplementary material)
Scientific Affairs Director
Hansa Biopharma AB
Lund, Sweden 

Cassie Stromayer Muran, PharmD, BCPS, BCTXP
Abdominal Transplant Clinical Pharmacist
University of Illinois Hospital and Health Sciences System
Clinical Assistant Professor, University of Illinois Chicago College of Pharmacy
Chicago, Illinois 

Dana R. Pierce, PharmD, BCTXP
Clinical Assistant Professor
Clinical Transplant Pharmacist
University of Illinois Chicago College of Pharmacy
Chicago, Illinois 

Lisa Potter, PharmD, FCCP, FAST, BCTXP, BCPS*
Clinical Coordinator, Transplant Pharmacy Services
University of Chicago Medicine
Chicago, Illinois 

Tara Veasey Rackley, PharmD, BCPS, BCTXP
Clinical Pharmacy Specialist, Cardiac Transplant
Allegheny General Hospital
Pittsburgh, Pennsylvania

Debbie Ramirez, PharmD, BCTXP, BCPS
Clinical Pharmacist, Value Based Care
Kidneylink
Plano, Texas 

Katie Suda, PharmD, MS, FCCP
Research Health Scientist and Associate Director, VA Center for Health Equity Research and Promotion
Tenured Professor of Medicine and Pharmacy & Therapeutics
Director, Transition to Independence Program
University of Pittsburgh Schools of Medicine and Pharmacy
Pittsburgh, Pennsylvania 

Lindsey P. Toman, PharmD, BCPS, BCTXP*
Transplant Clinical Pharmacy Specialist
PGY2 Solid Organ Transplant Residency Program Director
The Johns Hopkins Hospital
Baltimore, Maryland

*Content matter experts 

Lyndsey J. Bowman Anger, PharmD, FCCP, FAST, BCTXP, BCPS
Pharmacotherapy Specialist, Kidney and Liver Transplant
Tampa General Hospital
Tampa, Florida 

Jamie J. Benken, PharmD, BCPS
Clinical Pharmacist
University of Illinois Health
Clinical Assistant Professor
University of Illinois Chicago
Chicago, Illinois 

Mary Moss Chandran, PharmD, FCCP, FAST, BCTXP, BCPS, CPP
Clinical Pharmacist Practitioner
University of North Carolina Health
Adjunct Assistance Professor
University of North Carolina Eshelman School of Pharmacy
Chapel Hill, North Carolina 

Reed Hall, PharmD, BCPS, BCTXP
Solid Organ Transplant Lead Pharmacist
University Health
Adjoint Assistant Professor
University of Texas at Austin College of Pharmacy
San Antonio, Texas 

Lynley Heinrich, PharmD, BCTXP
Transplant Clinical Pharmacist
University of Illinois Health Medical Center
Clinical Assistant Professor
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois 

Edward Horn, PharmD, BCCCP
Associate Professor, Department of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Associate Director, Cardiac Transplant
UPMC Heart and Vascular Institute, Advanced Heart Disease Program
Pittsburgh, Pennsylvania 

Arin Jantz, PharmD, BCPS, BCTXP
Pharmacy Specialist, Solid Organ Transplant
Henry Ford Health
Detroit, Michigan

Jennifer L. Jebrock Kelly, PharmD, BCPS, BCTXP
Liver and GI Transplant Pharmacist
Jackson Memorial Hospital
Miami Transplant Institute
Miami, Florida 

Kayla Joyal, PharmD, FAST, BCTXP
Abdominal Transplant Clinical Pharmacist
Massachusetts General Hospital
Boston, Massachusetts 

Karen L. Kier, PhD, FCCP, BCPS, BCACP
Professor of Pharmacy Practice, Director of Drug and Health Information
Raabe College of Pharmacy
Ohio Northern University
Ambulatory Care Pharmacist
ONU HealthWise
Ada, Ohio 

Elisabeth Kincaide, PharmD, BCPS, BCTXP
Clinical Pharmacy Specialist III, Solid Organ Transplant at University Health
Adjunct Faculty
University of Texas at Austin College of Pharmacy
San Antonio, Texas 

Erica Maceira, PharmD, BCPS, BCTXP
Associate Directory of Pharmacy - Clinical Services
Renal Transplant Clinical Pharmacy Specialist
Albany Medical Center Hospital
Albany, New York 

Natalia M. Panek, PharmD, BCPS
Pediatric Solid Organ Transplant Pharmacist
Ann and Robert H. Lurie Children’s Hospital of Chicago
Chicago, Illinois 

Anastasia Serluco, PharmD, BCTXP
Pharmacist Specialist – Solid Organ Transplant
Residency Program Director, PGY2 Solid Organ Transplant
Children’s Healthcare of Atlanta
Atlanta, Georgia 

Helen Sweiss, PharmD, BCTXP
Solid Organ Transplant Pharmacist
University Health San Antonio
San Antonio, Texas 

Bo Young H. Yen, PharmD, BCPS, BCTXP
Staff II Pharmacist, Solid Organ Transplant
UCSF Medical Center
Health Science Assistant Professor
UCSF School of Pharmacy
San Francisco, California

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. 

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of this activity’s content have relevant financial relationships: 

Consultant/Advisory Board Member: Nicole R. Alvey (Veloxis Pharmaceuticals), Steven Gabardi (Merck, Takeda Pharmaceuticals), Tiffany E. Kaiser (Eurofins Transplant Genomics, Wolters Kluwer Health), Lindsey P. Toman (Wolters Kluwer Health), Jamie J. Benken (Trevena), Elisabeth Kincaide (Merck), Nicole R. Alvey (Veloxis Pharmaceuticals) 

Received Grant Funding/Research Support: Steven Gabardi (Shionogi Pharmaceuticals) 

Speakers Bureau: Tiffany E. Kaiser (Global Learning Collaborative), Lyndsey J. Bowman Anger (Veloxis Pharmaceuticals), Reed Hall (Veloxis Pharmaceuticals) 

Independent Contractor: Mary Moss Chandran (Eurofins Viracor) 

As required by the Standards of Integrity and Independence in Accredited Continuing Education, all relevant financial relationships have been mitigated prior to the CPE activity.

Activities can be completed in any order. Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity. 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

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To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for Board Certification Examinations.