{"id":703,"date":"2023-05-31T01:54:00","date_gmt":"2023-05-31T01:54:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=703"},"modified":"2025-10-01T11:39:36","modified_gmt":"2025-10-01T19:39:36","slug":"usmle-step-1-question-of-the-day-acute-transplant-rejection","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Acute transplant rejection"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#D_Dense_mononuclear_infiltration_of_the_interstitium_and_necrosis_of_the_arterial_wall\" >D. Dense mononuclear infiltration of the interstitium and necrosis of the arterial wall<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#A_Interstitial_fibrosis_with_tubular_atrophy\" >A. Interstitial fibrosis with tubular atrophy&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#B_Widespread_thrombosis_of_the_graft_vessels\" >B. Widespread thrombosis of the graft vessels<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#C_Interstitial_inflammation_tubular_fibrosis_with_basophilic_intranuclear_inclusions\" >C. Interstitial inflammation, tubular fibrosis with basophilic intranuclear inclusions<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#E_Interstitial_fibrosis_with_arteriolar_hyalinosis_and_tubular_vacuolization\" >E. Interstitial fibrosis with arteriolar hyalinosis and tubular vacuolization<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 55-year-old with a history of diabetic nephropathy and chronic kidney failure, who recently underwent a successful kidney transplant and is currently taking tacrolimus, presents with a 3-day fever. Physical examination reveals tenderness at the graft site. Lab results show a previous serum creatinine level of 1.1 mg\/dL, a current temperature of 38.5\u00b0C (101.3\u00b0F), pulse rate of 88\/minute, and blood pressure of 140\/90 mmHg. The patient is referred for a biopsy of the transplanted kidney. What is the most likely finding on histological examination of the biopsy?&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 55-year-old individual comes to the physician due to fever for the last three days. The patient has a history of diabetic nephropathy and chronic kidney failure and underwent successful kidney transplantation one month ago. The patient is currently taking tacrolimus. Temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 88\/minute, and blood pressure is 140\/90 mmHg. On physical examination, tenderness is noted in the graft site. Laboratory evaluation is shown below. Chart review from the previous visit two weeks ago shows a serum creatinine of 1.1 mg\/dL. BK virus DNA PCR test is negative. The patient is referred for a biopsy from the transplanted kidney. Which of the following is most likely to be seen on histological examination of the biopsy?<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Laboratory value<\/td><td>Result<\/td><\/tr><tr><td colspan=\"2\">Serum chemistry<\/td><\/tr><tr><td>Sodium<\/td><td>147 mEq\/L<\/td><\/tr><tr><td>Potassium&nbsp;<\/td><td>4.5 mEq\/L<\/td><\/tr><tr><td>Blood urea nitrogen<\/td><td>30 mg\/dL<\/td><\/tr><tr><td>Creatinine<\/td><td>2.3 mg\/d<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Interstitial fibrosis with tubular atrophy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Widespread thrombosis of the graft vessels<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Interstitial inflammation, tubular fibrosis with basophilic intranuclear inclusions<br><\/strong><br><strong>D. Dense mononuclear infiltration of the interstitium and necrosis of the arterial wall<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Interstitial fibrosis with arteriolar hyalinosis and tubular vacuolization<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Dense_mononuclear_infiltration_of_the_interstitium_and_necrosis_of_the_arterial_wall\"><\/span>D. Dense mononuclear infiltration of the interstitium and necrosis of the arterial wall<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Interstitial_fibrosis_with_tubular_atrophy\"><\/span>A. Interstitial fibrosis with tubular atrophy&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Interstitial fibrosis with tubular atrophy is seen in chronic transplant rejection, not acute transplant rejection.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Widespread_thrombosis_of_the_graft_vessels\"><\/span>B. Widespread thrombosis of the graft vessels<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Widespread thrombosis of the graft vessels is seen in patients with hyperacute transplant rejection, not acute transplant rejection.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Interstitial_inflammation_tubular_fibrosis_with_basophilic_intranuclear_inclusions\"><\/span>C. Interstitial inflammation, tubular fibrosis with basophilic intranuclear inclusions<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;BK virus is an opportunistic infection of transplanted kidneys that can lead to nephritis and graft failure. On histology, viral basophilic intranuclear inclusions can be seen in addition to interstitial inflammation and varying degrees of tubular atrophy and fibrosis. However, this patient has a negative BK DNA PCR test, making BK virus infection less likely the cause.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Interstitial_fibrosis_with_arteriolar_hyalinosis_and_tubular_vacuolization\"><\/span>E. Interstitial fibrosis with arteriolar hyalinosis and tubular vacuolization<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Tacrolimus toxicity on histology is characterized by interstitial fibrosis, arteriolar hyalinosis, and tubular vacuolization. In addition, patients may show acute tubular necrosis. However, tacrolimus nephrotoxicity occurs due to vasoconstriction of the afferent arterioles of the kidney, causing prerenal kidney injury where the BUN:Cr ratio is &gt;20 (unlike this patient).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/h3>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?w=700\" alt=\"Osmosis ad\" class=\"wp-image-513\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has fever, graft site tenderness, and abnormal kidney function test one month after kidney transplantation. This presentation is concerning for&nbsp;<strong>acute graft rejection.<\/strong>&nbsp;Although the incidence of acute renal graft rejection has decreased immensely after the introduction of immunosuppressant drugs, it is still one of the leading causes of rejection.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Acute rejection develops due to recognition of the graft antigens by the immune system, and it results from two immunological immune responses that act in combination or alone: the cellular and the humoral immune responses. The cellular response is mediated by&nbsp;<strong>T-cells<\/strong>, which directly recognize MHC antigens on the graft and cause damage to the graft (T-cell dependent process), while the humoral response develops when&nbsp;<strong>B cells<\/strong>&nbsp;are recruited (by T-helper cells) and generate antibodies that cause acute humoral rejection (B-cell dependent process). Therefore, acute rejection is considered a&nbsp;<strong>type II<\/strong>&nbsp;(antibody-mediated) and&nbsp;<strong>type IV<\/strong>&nbsp;(cellular-mediated) hypersensitivity reaction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Acute rejection develops from one week to three months after transplantation, and patients usually complain of&nbsp;<strong>fever<\/strong>&nbsp;and&nbsp;<strong>graft site tenderness<\/strong>. Additionally, there is typically decreased function of the transplanted organ; for example, patients with acute renal graft rejection develop&nbsp;<strong>anuria<\/strong>,&nbsp;<strong>metabolic abnormalities<\/strong>&nbsp;(e.g. hyperkalemia), and&nbsp;<strong>elevated serum creatinine<\/strong>, as seen in this patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A biopsy is needed to diagnose acute graft rejection and differentiate it from other diagnoses (e.g. tacrolimus toxicity). Histologically, acute graft rejection is characterized by\u00a0<strong>mononuclear lymphocytic infiltrate\u00a0in the interstitium<\/strong>\u00a0of the graft tissue along with\u00a0<strong>necrosis of the arterial walls<\/strong>\u00a0(vasculitis).<br><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"870\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_043a41.webp\" alt=\"mononuclear lymphocytic infiltrate\u00a0in the interstitium\u00a0of the graft tissue along with\u00a0necrosis of the arterial walls\u00a0(vasculitis). from wikipedia\" class=\"wp-image-706\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_043a41.webp 1024w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_043a41.webp?resize=300,255 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_043a41.webp?resize=768,653 768w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Reproduced from:&nbsp;<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Acute_cellular_rejection,_renal_graft_biopsy.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikipedia<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Acute graft rejection is mediated by both T-cells (type IV hypersensitivity reaction) and antibodies (type II hypersensitivity reaction) that recognize the graft antigens and cause damage to the transplanted organ. It is characterized by dense lymphocytic interstitial infiltration along with vasculitis of the arterial walls.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Justiz Vaillant AA, Misra S, Fitzgerald BM. Acute Transplantation Rejection. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535410\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535410\/<\/a>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Naik RH, Shawar SH. Renal Transplantation Rejection. [Updated 2020 Dec 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553074\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553074\/<\/a>\u00a0<br><em><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png?w=700\" alt=\"\" class=\"wp-image-615\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 55-year-old with a history of diabetic nephropathy and chronic kidney failure, who recently underwent a successful kidney transplant and is currently taking tacrolimus, presents with a 3-day fever. Physical examination reveals tenderness at [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":704,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-703","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Acute transplant rejection - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Acute transplant rejection - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 55-year-old with a history of diabetic nephropathy and chronic kidney failure, who recently underwent a successful kidney transplant and is currently taking tacrolimus, presents with a 3-day fever. Physical examination reveals tenderness at [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-31T01:54:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:39:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/35.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-acute-transplant-rejection\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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