Template:Transplant emergency types

Types of Transplant complications

• Immediate (0-1 week)
  • Acute Tubular Necrosis
    • May be post-ischemic, commonly effecting both the proximal tubules and the thick ascending limb. Or it may be immunosupresive drug induced and only effect the proximal tubules. Granular "muddy brown casts" seen on urinalysis result from death and sloughing of tubular cells.
  • Antibody mediated rejection
    • Results from donor specific antibodies including as ABO isoagglutinins.
    • Usually results in graft loss within 24 hours.
  • Embolization and Thrombosis
    • May arise with or without rejection
    • May result from hypotension, anastomotic stenosis, arterial dissection, kinking of transplanted artery, or angulation of the vein
  • Calcium Oxalate deposition
  • Delayed graft function
    • This is defined as renal failure persisting after transplantation necessitating dialysis. It my be due to post-ischemic acute tubular necrosis, volume depletion, or volume depletion.
  • Urinary bladder dysfunction
    • This complication is especially common in diabetics and may cause hydronephrosis

• Early (1-12 weeks)
  • Acute rejection
  • Immunosuppressive Cytotoxicity
    • Usually caused by calcineurin inhibitor toxicity
  • Infection
  • Recurrence of primary disease

• Late Acute (greater than 3 months)
  • Hypertension
  • Renal artery stenosis
  • Acute Rejection
  • Immunosuppressive cytotoxicity

• Late Chronic (years later)
  • Chronic allograph nephropathy
  • Immunosuppressive cytotoxicity

• transplant-related infection
• medication side effects
• rejection
• graft-versus-host disease
• postoperative complications and complications of altered physiology secondary to the transplanted organ
• Normal medical problems requiring unique management due to altered physiology