There are numerous toxicities and adverse effects associated with immunosuppression. Which of the following statement(s) is/are true concerning complications of immunosuppression?

b. Immunosuppressive agents may blunt the inflammatory response to infection leading to a late presentation of an infectious process

The most obvious complication of immunosuppression is infection. As immunosuppression becomes stronger and more effective, the recipient’s ability to resist infection diminishes. Transplant recipients are susceptible both to typical bacterial infections (UTI, pneumonia, wound infections) and to infections with unusual organisms (fungus, virus, atypical bacteria). Immunosuppressives also block the inflammatory response to infection so that patients present with very subtle signs and symptoms or they present late in the infectious process.

Another complication in allograft recipients is malignancy. The immunosuppressive drugs do not appear to be directly mitogenic or transforming, but rather probably suppress immune mechanisms which keep transformed cells in check. Squamous cell carcinomas of the exposed area of the skin are by far the most common malignancy. Lymphomas are the next most common tumor and are 10–100 times more common in transplant recipients than in the general population. These are usually non-Hodgkins B cell lymphomas and are often related to malignant transformation by Epstein-Barr virus (EBV).

Another complication of organ allografting is graft-vs-host disease (GVHD). GVHD is usually self-limited as donor cells, stimulated by the host alloantigen, are eliminated either by immunosuppression or by host anti-donor responses.