Solid Organ Transplantation Pharmacy Specialty Certification: Review Course Package (No Recert Credit) (L269143)

This course consists of 19 activities (see table below) and provides up to 25.5 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.

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

ACPE Number: 0217-9999-26-185-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 across various organ transplants.
• Develop evidence-based induction protocols tailored to donor, recipient, and transplant factors.
• Contrast agents used in the treatment of acute cellular rejection (ACR).
• Determine optimal therapeutic strategies for managing ACR. 

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.

ACPE Number: 0217-9999-26-186-H01-P

Kidney Transplantation

• Assess non-pharmacologic and pharmacologic risks of patients undergoing kidney transplant evaluation.
• Evaluate effects of nonadherence on long-term allograft survival.
• 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 Transplant

• Examine 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

• 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 Transplantation

• Describe the etiologies of intestinal transplantation.
• Develop an immunosuppression plan for intestinal transplant recipients to prevent and treat rejection.
• Manage the common complications observed after intestinal transplantation.

ACPE Number: 0217-9999-26-187-H01-P

Heart Transplantation

• Interpret common indications that may lead to heart transplantation.
• Identify pre-transplant risk factors that may impact outcomes after heart transplantation.
• Compare heart techniques for rejection surveillance.
• Differentiate heart specific pathologic findings.
• Select strategies for management of heart specific post-transplant complications. 

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 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

• Distinguish common immunosuppression approaches in heart transplantation.
• Design 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: 0217-9999-26-188-H01-P

Approaches to Prevent and Manage Antibody Development

• Describe the immunologic mechanisms that contribute to donor‑specific antibody (DSA) formation and their impact on allograft outcomes.
• Evaluate the role of immunologic event monitoring, including DSA surveillance strategies, in identifying and mitigating risk for antibody‑mediated rejection (ABMR).
• Compare evidence based desensitization strategies for HLA incompatible transplantation.
• Assess approaches to immunosuppression management (including induction, maintenance, and weaning after allograft failure) to prevent antibody formation and reduce sensitization risk. 

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. 

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​.

ACPE Number: 0217-9999-26-189-H01-P

Prevention and Management of Malignancy in Solid Organ Transplant Patients

• 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 sarcoma. 

Special Considerations in Pediatric and Geriatric Transplant Populations 

Pediatric

• 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 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. 

Geriatric

• 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: 0217-9999-26-190-H04-P

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

• Distinguish 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.
• Illustrate 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.
• Investigate the common obstacles and potential solutions to proper medication adherence post-transplant including health literacy, cultural competence and language and sensory barriers.
• Evaluate 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.
• Evaluate regulations that may involve SOT pharmacists.
• Apply 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.
• Demonstrate involvement of SOT pharmacists in collaborative relationships with interdisciplinary transplant team to promote quality patient care across the continuum. 

Transplant Resources, Patient Education, and 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 Risk Evaluation and Mitigation Strategies (REMS) participation.
• Formulate an appropriate contraceptive regimen for a female transplant recipient of childbearing age.
• Evaluate patient risk factors for nonadherence and implement a plan to improve compliance.
• Review transplant study endpoints used in the literature to establish efficacy of clinical intervention.

ACPE Number: 0217-9999-26-191-H99-P

Trial Design and Biostatistics

• Describe hypothesis testing and state the meaning of and distinguish between P values, CIs, and measures of central tendency and data spread.
• Define, compare, and contrast the concepts of internal and external validity, causation, association, bias, confounding, subgroup analysis, surrogate end points, and composite end points in trial design.
• 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, and meta-analysis).
• Determine why a statistical test is appropriate or not appropriate, given the sample distribution, data type, and study design. 

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. 

ASHP and ACCP collaborate on solid organ transplantation activities.

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.