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Which class of human leukocyte antigens (HLA) includes the A, B, and C loci?

A
B
C
D
to track
2026 Statistics

Key Facts: BCSCP Exam

150

Total Exam Items

BPS (125 scored + 25 pretest)

3h 45m

Exam Time

BPS

$600

Initial Application Fee

BPS 2026 ($300 retake)

BCTXP

Official BPS Abbreviation

Board of Pharmacy Specialties

4 yrs

Practice Experience (non-residency pathway)

BPS eligibility (50%+ SOT)

7 yrs

Recertification Cycle

BPS (exam + up to 20 CPD units)

The BCSCP exam (BPS credential abbreviation BCTXP - Board Certified Transplant Pharmacist) is a 150-item, 3-hour 45-minute computer-based exam with 125 scored items and 25 unscored pretest items. BPS charges a $600 initial application fee and a $300 retake fee. The exam is offered through continuously available testing (transitioned Q3 2025) and covers transplant biology, transplantation process, pretransplant evaluation, perioperative management, immunosuppression, post-transplant complications and infections, and professional practice. BPS does NOT publish a fixed percentage passing score - results use a criterion-referenced scaled score.

Sample BCSCP Practice Questions

Try these sample questions to test your BCSCP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which class of human leukocyte antigens (HLA) includes the A, B, and C loci?
A.Class I
B.Class II
C.Class III
D.Class IV
Explanation: HLA Class I antigens include the A, B, and C loci and are expressed on virtually all nucleated cells. They present intracellular (endogenous) peptides to CD8+ cytotoxic T cells.
2Which HLA class II locus is considered the most important for kidney transplant matching?
A.HLA-DP
B.HLA-DQ
C.HLA-DR
D.HLA-DM
Explanation: HLA-DR is the most important class II locus for kidney transplant matching. The standard 6-antigen match considers HLA-A, HLA-B, and HLA-DR (2 alleles each).
3Signal 1 in T-cell activation involves:
A.Binding of CD28 to CD80/CD86
B.TCR recognition of antigen-MHC complex
C.IL-2 binding to the IL-2 receptor
D.Calcineurin dephosphorylation of NFAT
Explanation: Signal 1 is the T-cell receptor (TCR) recognition of an antigen presented by MHC on an antigen-presenting cell. This initiates the calcium-calcineurin-NFAT pathway, which is the target of calcineurin inhibitors.
4Which rejection type is mediated by preformed antibodies and typically occurs within minutes to hours after transplantation?
A.Hyperacute rejection
B.Acute cellular rejection
C.Chronic rejection
D.Subclinical rejection
Explanation: Hyperacute rejection is mediated by preformed donor-specific antibodies (DSA) against ABO or HLA antigens. It occurs within minutes to hours of reperfusion and is now rare due to crossmatch testing.
5The Banff classification is used to grade rejection in which organ?
A.Heart
B.Lung
C.Kidney
D.Liver
Explanation: The Banff classification is the internationally accepted standard for grading kidney allograft rejection on biopsy. It categorizes T-cell mediated rejection (I, II, III) and antibody-mediated rejection.
6C4d staining on biopsy is a key marker for which type of rejection?
A.T-cell mediated rejection
B.Antibody-mediated rejection (AMR)
C.Hyperacute rejection
D.Chronic allograft nephropathy
Explanation: C4d is a complement degradation product that deposits in peritubular capillaries when antibodies activate complement. Positive C4d staining supports a diagnosis of antibody-mediated rejection (AMR).
7Thymoglobulin (rabbit ATG) works primarily by:
A.Blocking IL-2 receptor on T cells
B.Depleting T-lymphocytes
C.Inhibiting calcineurin
D.Blocking CD28 costimulation
Explanation: Rabbit antithymocyte globulin (rATG, Thymoglobulin) is a polyclonal antibody that depletes T-lymphocytes via complement-mediated lysis and apoptosis. It is used for induction and treatment of steroid-resistant rejection.
8Basiliximab (Simulect) is typically dosed as:
A.20 mg IV day 0 and day 4
B.1.5 mg/kg IV daily for 5 days
C.30 mg IV once weekly
D.0.3 mg/kg subcutaneously every 2 weeks
Explanation: Basiliximab is administered as 20 mg IV on day 0 (within 2 hours before transplant) and repeated on day 4 post-transplant. It is a chimeric monoclonal antibody against CD25 (IL-2 receptor alpha chain).
9Which of the following is the primary mechanism of action of tacrolimus?
A.Inhibition of mTOR
B.Inhibition of calcineurin via FKBP-12 binding
C.Inhibition of inosine monophosphate dehydrogenase (IMPDH)
D.Blockade of the IL-2 receptor
Explanation: Tacrolimus binds to FKBP-12, and this complex inhibits calcineurin. This prevents dephosphorylation of NFAT and blocks transcription of IL-2 and other cytokines, inhibiting T-cell activation.
10Which enzyme system is primarily responsible for tacrolimus metabolism?
A.CYP2D6
B.CYP3A4/5
C.UGT1A1
D.CYP2C9
Explanation: Tacrolimus is extensively metabolized by CYP3A4 and CYP3A5. It is also a P-glycoprotein substrate. CYP3A5 expressers (carriers of CYP3A5*1) require higher tacrolimus doses to achieve target troughs.

About the BCSCP Exam

The Board Certified Solid Organ Transplantation Pharmacy Specialist credential (BPS officially uses the abbreviation BCTXP - Board Certified Transplant Pharmacist) is administered by the Board of Pharmacy Specialties. It certifies pharmacists who provide advanced pharmacotherapeutic care to solid organ transplant (SOT) candidates and recipients. The exam is a 3-hour 45-minute, 150-item computer-based test delivered through continuously available testing.

Assessment

150 multiple-choice items (125 scored + 25 unscored pretest) covering transplant immunology, induction and maintenance immunosuppression, organ-specific management (kidney, liver, heart, lung, pancreas, intestine), infection prophylaxis, complications (rejection, PTLD, skin cancer), and professional practice.

Time Limit

3 hours 45 minutes

Passing Score

Criterion-referenced scaled score (BPS does not publish a fixed percentage passing score)

Exam Fee

$600 initial application ($300 retake) (BPS (Board of Pharmacy Specialties))

BCSCP Exam Content Outline

19%

Solid Organ Transplantation Foundations

Transplant biology (HLA, immunology, MHC, rejection pathways) and transplantation process (donor evaluation, organ allocation via UNOS/OPTN, listing, KDIGO/MELD/ISHLT criteria)

17%

Pretransplant Evaluation and Listing

Candidate selection, comorbidity management, HCV/HBV/HIV screening, vaccination pre-transplant, psychosocial evaluation, and desensitization (IVIG, plasmapheresis, rituximab)

14%

Perioperative and Induction Management

Induction immunosuppression (rATG/Thymoglobulin, basiliximab, alemtuzumab), surgical prophylaxis, DVT prophylaxis, pain, PONV, and early post-op pharmacotherapy

22%

Maintenance Immunosuppression and TDM

CNIs (tacrolimus, cyclosporine), mTOR inhibitors (sirolimus, everolimus), antiproliferatives (MMF, MPA, azathioprine), corticosteroids, belatacept; therapeutic drug monitoring; drug interactions (CYP3A4/PGP)

14%

Infection Prophylaxis and Treatment

CMV (valganciclovir, letermovir), PJP (TMP-SMX), HSV/VZV, fungal (fluconazole, voriconazole, posaconazole), BK polyomavirus, EBV, HBV/HCV, vaccination post-transplant

9%

Post-transplant Complications and Long-term Care

Acute cellular and antibody-mediated rejection, chronic allograft dysfunction, PTLD, PTDM, CV disease, skin cancer, pregnancy, bone disease, recurrent disease

5%

Professional Practice, Research, and Ethics

Organ allocation ethics, transitions of care, guideline interpretation (KDIGO, ISHLT, AST/ASTS), literature evaluation, and pharmacoeconomics

How to Pass the BCSCP Exam

What You Need to Know

  • Passing score: Criterion-referenced scaled score (BPS does not publish a fixed percentage passing score)
  • Assessment: 150 multiple-choice items (125 scored + 25 unscored pretest) covering transplant immunology, induction and maintenance immunosuppression, organ-specific management (kidney, liver, heart, lung, pancreas, intestine), infection prophylaxis, complications (rejection, PTLD, skin cancer), and professional practice.
  • Time limit: 3 hours 45 minutes
  • Exam fee: $600 initial application ($300 retake)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

BCSCP Study Tips from Top Performers

1Master CNI pharmacology cold: tacrolimus vs cyclosporine trough ranges by organ and time post-transplant, CYP3A4/PGP interactions (azoles, macrolides, diltiazem, verapamil, rifampin, grapefruit, St. John's Wort), nephrotoxicity, and organ-specific nuances
2Know CMV prophylaxis by donor/recipient serostatus (D+/R-, D+/R+, D-/R+, D-/R-), valganciclovir vs letermovir, and duration recommendations for each organ
3Build a 'rejection matrix' - hyperacute (preformed DSA/ABO), acute cellular (T-cell, Banff), antibody-mediated (DSA, C4d), chronic (CAV heart, CLAD lung, IFTA kidney, ductopenia liver) - with first-line treatments
4Complete the ACCP/ASHP Transplantation Pharmacy Review Course and SOTSAP self-assessment in parallel - they mirror exam content weights
5Drill guideline recommendations: KDIGO (kidney), AST-IDCOP (infections), ISHLT (heart/lung), and AASLD (liver) - many questions map directly to guideline algorithms

Frequently Asked Questions

What is the BCSCP exam and who administers it?

BCSCP is the Board Certified Solid Organ Transplantation Pharmacy Specialist credential administered by the Board of Pharmacy Specialties (BPS). Note: BPS itself uses the abbreviation BCTXP (Board Certified Transplant Pharmacist) for the Solid Organ Transplantation Pharmacy specialty - BCSCP is used synonymously on many job postings. The exam is 150 multiple-choice items (125 scored + 25 unscored pretest) administered over 3 hours and 45 minutes via continuously available computer-based testing.

Is BCSCP the same as BCTXP? What about BPS Sterile Compounding?

Yes, BCSCP and BCTXP refer to the SAME credential - BPS Solid Organ Transplantation Pharmacy. The OFFICIAL BPS abbreviation is BCTXP (Board Certified Transplant Pharmacist). IMPORTANT: Do NOT confuse this with BPS Compounded Sterile Preparations Pharmacy, which is a separate BPS specialty. If you see 'BCSCP' in a job posting, ask the employer to clarify - most often it refers to the transplant specialty.

What are the eligibility requirements for the BCSCP / BCTXP exam?

Candidates must (1) graduate from an ACPE-accredited pharmacy program (or equivalent outside the U.S.), (2) hold a current, active pharmacist license, AND complete ONE of the following practice pathways: (a) 4 years of practice post-licensure with at least 50% of time spent in solid organ transplant (SOT) pharmacy; (b) completion of a PGY-1 residency PLUS 2 additional years of practice with at least 50% SOT time; or (c) completion of a PGY-2 residency in Solid Organ Transplantation Pharmacy.

How much does the BCSCP exam cost?

The BPS initial application / examination fee is $600 USD for first-time applicants. The retake fee is $300 USD. There is no separate application fee - it is included in the $600. Recertification has its own fee structure published on bpsweb.org. Preparatory review courses (e.g., ACCP/ASHP Transplantation Pharmacy Prep Course, SOTSAP) are an additional cost, typically $500-$1,500 for members.

How many questions are on the BCSCP exam and how long is it?

The BCSCP / BCTXP exam consists of 150 multiple-choice items delivered in 3 hours and 45 minutes. Of the 150 items, 125 are scored and 25 are unscored pretest items being trialed for future exams. Each item is typically single-best-answer with 4 options. The exam is delivered via Prometric and uses continuous availability testing starting Q3 2025.

What is the passing score for the BCSCP exam?

BPS uses a criterion-referenced scaled scoring system - they do NOT publish a fixed percentage passing score. Each candidate receives a scaled score and a pass/fail determination. BPS cycle-level pass rates have historically ranged from approximately 65-80% for solid organ transplantation pharmacy. Beginning January 2026, BPS provides an immediate preliminary score report, with final results within 45 calendar days.

How long should I study for the BCSCP exam?

Plan 150-300 hours of focused study over 4-6 months. Most candidates complete the ACCP/ASHP Solid Organ Transplantation Pharmacy Preparatory Review Course (30-40 hours of recorded content), work through SOTSAP self-assessment, review KDIGO, ISHLT, AST Infectious Diseases Community of Practice guidelines, and drill 500+ practice questions. Target scoring 75%+ on timed practice sets before scheduling.

What topics are weighted most heavily on the BCSCP exam?

Maintenance immunosuppression and therapeutic drug monitoring (~22%) is the single largest domain. Transplant biology and process (~19%) and pretransplant evaluation (~17%) together make up more than a third of the exam. Infection prophylaxis (~14%) and perioperative/induction (~14%) are also major sections. Master CNI drug interactions (CYP3A4), CMV risk stratification and prophylaxis, HLA and DSA interpretation, and rejection pathways.