Difference between revisions of "Transplant complications"

(InfectionsLong B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.)
 
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==Background==
 
==Background==
*Transplanted organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines)
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*Transplanted (solid) organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines)
*Most transplant patients require lifelong immunosuppression
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*Most transplant-related emergencies due to one of the following:
*Types of emergencies
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**Infection
**transplant-related infection
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**Medication side effect
**medication side effects
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**[[Graft-versus-host disease]]
**rejection
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**Postoperative complications
**graft-versus-host disease
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**Altered physiology due to transplanted organ
**postoperative complications and complications of altered physiology secondary to the transplanted organ
 
*Often transplant patients present with common medical problems but require unique management due to their altered physiology <ref>Tintinalli's</ref>
 
  
 
===Epidemiology===
 
===Epidemiology===
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*Acute graft-versus-host disease occurs in 20% to 80% of patients post-hematopoietic stem cell transplantation (HSCT); rarely occurs in solid organ transplant <ref>Tintinalli's</ref>
 
*Acute graft-versus-host disease occurs in 20% to 80% of patients post-hematopoietic stem cell transplantation (HSCT); rarely occurs in solid organ transplant <ref>Tintinalli's</ref>
  
==Complications Due to Immunosuppressant Medications==
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{{Immunosuppressant medication complications}}
*Balance between immune suppression, rejection and susceptibility to infection
 
*Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
 
**Calcineurin inhibitor
 
***Cyclosporine
 
***Tacrolimus
 
**Antimetabolite
 
***Azathioprine
 
***Mycophenolate Mofetil (MMF)
 
**Steroid
 
***Prednisone/Prednisolone
 
  
==Clinical Features==
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===Infections<ref>Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.</ref>===
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Time from transplantation affects the risk and type of infection.
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*Early (within the first month)
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**Donor-derived - bacterial, fungal, parasitic
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**Nosocomial & surgical-site - [[C. diff]], [[aspiration Pneumonia]], [[UTI]], surgical-site, superinfection of graft tissue
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*Intermediate (1-6 months after)
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**'''Highest risk for opportunistic infections''' - [[PCP]], [[TB]], fungal ([[cryptococcus]], [[histoplasma]]), viral (BK virus, [[hepatitis B]]/[[hepatitis C|C]], [[CMV]])
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**Dormant host infection reactivation - [[HSV]], [[VZV]], [[EBV]]
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*Late (more than 6 months after)
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**Community-acquired infection
  
==Differential Diagnosis==
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==Types==
 
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*[[Graft-vs-host disease]]
==Diagnosis==
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*[[Stem cell transplant complications]]
 
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*[[Kidney transplant complications]]
==Management==
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*[[Liver transplant complications]]
 
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*[[Heart transplant complications]]
==Disposition==
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*[[Lung transplant complications]]
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*[[Pancreas transplant complications]]
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*More severe or opportunistic infections due to immunocompromise
 +
**May be afebrile due to immunosuppression, have low treshhold for infectious work-up
  
 
==See Also==
 
==See Also==
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*[[Immunocompromised antibiotics]]
  
 
==External Links==
 
==External Links==
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<references/>
 
<references/>
  
[[Category:Surg]]
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[[Category:Surgery]]
 
[[Category:Misc/General]]
 
[[Category:Misc/General]]

Latest revision as of 02:36, 23 August 2019

Background

  • Transplanted (solid) organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines)
  • Most transplant-related emergencies due to one of the following:
    • Infection
    • Medication side effect
    • Graft-versus-host disease
    • Postoperative complications
    • Altered physiology due to transplanted organ

Epidemiology

  • Types of presentations
    • Infection (39%)
    • Noninfectious GI/GU pathology (15%)
    • Dehydration (15%)
    • Electrolyte disturbances (10%)
    • Cardiopulmonary pathology (10%)
    • Injury (8%)
    • Rejection (6%)
  • Acute graft-versus-host disease occurs in 20% to 80% of patients post-hematopoietic stem cell transplantation (HSCT); rarely occurs in solid organ transplant [1]

Immunosuppressant Medications

Infections[2]

Time from transplantation affects the risk and type of infection.

  • Early (within the first month)
    • Donor-derived - bacterial, fungal, parasitic
    • Nosocomial & surgical-site - C. diff, aspiration Pneumonia, UTI, surgical-site, superinfection of graft tissue
  • Intermediate (1-6 months after)
  • Late (more than 6 months after)
    • Community-acquired infection

Types

See Also

External Links

References

  1. Tintinalli's
  2. Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.