Solid Organ Transplantation Pharmacy Specialty Review Course and Practice Exam (No Recert Credit) (Cert # L229238)

The American College of Clinical Pharmacy and American Society of Health-System Pharmacists are accredited by the Accreditation Council for Pharmacy Education as providers of continuing pharmacy education. 

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 17 activities (see table below) and provides up to 22 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.  

At the end of the presentations, the pharmacist should be able to: 

Transplant Immunology
ACPE #: 0217-9999-22-110-H01-P

• 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
ACPE #: 0217-9999-22-111-H01-P

• 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. 

Maintenance of Immunosuppression Part One
ACPE #: 0217-9999-22-112-H01-P

• 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. 

Kidney Transplantation
ACPE #: 0217-9999-22-113-H01-P

• 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
ACPE #: 0217-9999-22-114-H01-P

• 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
ACPE #: 0217-9999-22-115-H01-P

Pancreas and Islet Cell

• 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

• 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. 

Heart Transplantation
ACPE #: 0217-9999-22-116-H01-P

• 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
ACPE #: 0217-9999-22-117-H01-P

• 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
ACPE #: 0217-9999-22-118-H01-P

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. 

Infection Prevention and Management in Solid Organ Transplant Patients
ACPE #: 0217-9999-22-119-H01-P

• 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 Patients
ACPE #: 0217-9999-22-120-H01-P

• 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. 

Primary Care of the Solid Organ Transplant Patient
ACPE #: 0217-9999-22-121-H01-P

• 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
ACPE #: 0217-9999-22-122-H01-P

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 candidates.

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. 

Trial Design and Biostatistics
ACPE #: 0217-9999-22-050-H04-P

• Describe hypothesis testing and state the meaning of and distinguish between p values and 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 bias and improve internal and external validity.
• 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. 

Continuity of Care and Managing Transitions of Care in the Transplant Patient
ACPE #: 0217-9999-22-123-H01-P

• 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.
• Evaluate 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.
• Differentiate between various medication access resources in solid organ transplant recipients. 

Transplant Regulations and Performance Improvement
ACPE #: 0217-9999-22-124-H03-P

• Review regulations for solid organ transplantation (SOT) programs.
• Compose 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 SOT guidelines in order to identify areas failing to meet expectations and implement performance improvement initiatives.
• Implement processes for cost effective care focusing on continuous quality improvement, patient safety and outcomes in order to justify modifications in transplantation pharmacy services.
• 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
ACPE #: 0217-9999-22-125-H99-P

• 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.

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

Maya Campara, Pharm.D., FCCP, FAST, BCPS
Clinical Associate Professor, Pharmacy Practice and Surgery
University of Illinois at Chicago
Chicago, Illinois

Jillian P. Casale, Pharm.D., BCPS, BCTXP
Clinical Pharmacy Specialist, Solid Organ Transplant
University of Maryland Medical Center
Assistant Professor
University of Maryland School of Pharmacy
Baltimore, Maryland

Amanda J. Condon Martinez, Pharm.D., BCTXP, BCPS
Clinical Pharmacist, Value Based Care
Kidneylink
Plano, Texas

Steven Gabardi, Pharm.D., FCCP, FAST, BCPS
Abdominal Organ Transplant Clinical Specialist
Brigham and Women’s Hospital
Assistant Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Jennifer C. Hagopian, Pharm.D., BCPS
Clinical Pharmacy Specialist, Solid Organ Transplant
Michigan Medicine
Ann Arbor, Michigan

Kimberly Harrison, Pharm.D., BCPS, BCTXP
Cardiothoracic Transplant Clinical Specialist
Vanderbilt University Medical Center
Nashville, Tennessee

Edward Horn, Pharm.D., BCCCP
Associate Professor, Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Clinical Pharmacist, Cardiac Transplant and Mechanical Circulatory Support
UPMC Heart and Vascular Institute
Pittsburgh, Pennsylvania

Tim Humlicek, Pharm.D.
Clinical Pharmacy Specialist, Solid Organ Transplant
Texas Children’s Hospital
Houston, Texas

Tiffany E, Kaiser, Pharm.D., MS, FCCP
Transplant Clinical Pharmacist
Director, Solid Organ Transplant Quality
University of Cincinnati
Cincinnati, Ohio

Clare Kane, Pharm.D., BCTXP, BCPS
Clinical Pharmacist, Solid Organ Transplant
Northwestern Memorial Hospital
Chicago, Illinois

Alicia Lichvar, Pharm.D., M.S., BCPS, BCTXP
Clinical Transplant Pharmacist
Center for Transplantation
University of California San Diego Health
La Jolla, California

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

Lisa Potter, Pharm.D., FCCP, FAST, BCTXP, BCPS
Clinical Coordinator, Transplant Pharmacy Services
University of Chicago Medicine
Chicago, Illinois

Chelsea Sammons, Pharm.D.
Liver and VCA Transplant Clinical Pharmacy Specialist
The Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Maressa Santarossa, Pharm.D., BCPS, BCIDP
Transplant Infectious Diseases Clinical Pharmacist
Loyola University Medical Center
Maywood, Illinois

Katie Suda, Pharm.D., M.S., FCCP
Professor
Department of Medicine
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

Lindsey P. Toman, Pharm.D., BCPS, BCTXP
Liver Transplant Clinical Pharmacy Specialist,
PGY2 Solid Organ Transplant Residency Program Director
The John Hopkins Hospital
Baltimore, Maryland

*Content Matter Experts

Nicole R. Alvey, Pharm.D., BCTXP, BCPS, FAST
Associate Professor of Clinical Sciences
Roosevelt University College of Pharmacy
Clinical Pharmacy Specialist, Solid Organ Transplant
Rush University Medical Center
Chicago, Illinois

Jamie Benken, Pharm.D., BCPS
Clinical Pharmacist
University of Illinois Health
Clinical Assistant Professor
University of Illinois Chicago
Chicago, Illinois

Lyndsey J. Bowman Anger, Pharm.D., FCCP, FAST, BCTXP, BCPS
Pharmacotherapy Specialist, Abdominal Transplant
Tampa General Hospital
Tampa, Florida

Jennifer Trofe-Clark, Pharm.D., FCCP, FAST, BCPS
Adjunct Professor of Surgery, Transplantation Division, Department of Surgery and
Adjunct Professor of Medicine, Renal-Electrolyte and Hypertension Division, Department of Medicine
Perelman School of Medicine
Philadelphia, Pennsylvania

Adam B. Cochrane, Pharm.D., MPH, BCTXP
Organ Tranplant Clinical Pharmacy Specialist
Inova Fairfax Hospital
Falls Church, Virginia

Frank A. Fanizza, Pharm.D., BCACP, AAHIVP
Ambulatory Care Clinical Pharmacist
LMH Health
Lawrence, Kansas

Reed Hall, Pharm.D., BCPS
Solid Organ Transplant Clinical Specialist
University Health, San Antonio
Adjoint Assistant Professor
University of Texas College of Pharmacy
San Antonio, Texas

Lynley Heinrich, Pharm.D., BCPS
Solid Organ Transplant Clinical Pharmacist
University of Illinois Hospital & Health System
Clinical Assistant Professor
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois

Arin Jantz, Pharm.D., BCPS, BCTXP
Pharmacy Specialist, Solid Organ Transplant
PGY2 Solid Organ Transplant Pharmacy Residency Director
Henry Ford Health
Detroit, Michigan

Jennifer L. Jebrock, Pharm.D., BCPS, BCTXP
Liver and GI Transplant Pharmacist
Jackson Memorial Hospital
Miami, Florida

Robin Klasek, Pharm.D., BCPS
Medical Science Liaison
Takeda Pharmaceuticals
Boston, Massachusetts

Erica Maceira, Pharm.D., BCPS, BCTXP
Associate Directory of Pharmacy - Clinical Services
Renal/Pancreas Transplant Pharmacist
Albany Medical Health Systems
Albany, New York

Angela Maldonado, Pharm. D., CPP, BCPS, FCCP, FAST
Scientific Affairs Director
Hansa Biopharma AB
Lund, Sweden

Jennifer K. McDermott, Pharm.D., BCTXP, BCPS
Clinical Pharmacy Specialist, Solid Organ Transplantation
Spectrum Health
Adjunct Assistant Professor
Michigan State University, College of Human Medicine, Department of Medicine
Grand Rapids, Michigan

Joelle E. Nelson, Pharm.D., BCPS
Clinical Pharmacy Specialist, Solid Organ Transplant
University Health
San Antonio, Texas

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

Bharath R. Ravichandran, Pharm.D.
Associate Director, Guidehouse Consulting
Clinical Assistant Professor
University of Maryland School of Pharmacy
Baltimore, Maryland

Michael Shullo, Pharm.D.
Vice President – Transplant
West Virginia University Hospitals
Professor
West Virginia University School of Pharmacy
Morgantown, West Virginia

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: Jillian P. Casale (Veloxis Pharmaceuticals), Steven Gabardi (Merck Pharmaceuticals), Cassie Stomayer-Muran (Veloxis Pharmaceuticals), Lisa Potter (Takeda), Chelsea Sammons (Mallinckrodt Pharmaceuticals), Lindsey P. Toman (Wolters Kluwer), Nicole Alvey (Care DX; Veloxis Pharmaceuticals), Lyndsey J. Bowman Anger, (Veloxis Pharmaceuticals), Jennifer Trofe Clark (Care Dx, MedActionPlan)
• Received Grant Funding/Research Support: Lisa Potter (Astellas), Joelle E. Nelson (Care Dx)
• Speakers Bureau: Jennifer C. Hagopian (Veloxis Pharmaceuticals), Lyndsey J. Bowman Anger(Veloxis Pharmaceuticals), Jennifer Trofe-Clark (Veloxis Pharmaceuticals)
• Scientific Advisor: Michael Shullo (Natera) 

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

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.

ACCP and ASHP 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.