Transplant complications: Difference between revisions

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==Background==
==Background==
*Transplanted organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines)
*Transplanted (solid) organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines)
*Most transplant patients require lifelong immunosuppression
*Most transplant-related emergencies due to one of the following:
*Types of emergencies
**Infection
**transplant-related infection
**Medication side effect
**medication side effects
**[[Graft-versus-host disease]]
**rejection
**Postoperative complications
**graft-versus-host disease
**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==
{{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==
===Infections<ref>Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.</ref>===
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)
**'''Highest risk for opportunistic infections''' - [[PCP]], [[TB]], fungal ([[cryptococcus]], [[histoplasma]]), viral (BK virus, [[hepatitis B]]/[[hepatitis C|C]], [[CMV]])
**Dormant host infection reactivation - [[HSV]], [[VZV]], [[EBV]]
*Late (more than 6 months after)
**Community-acquired infection


==Differential Diagnosis==
==Types==
 
*[[Graft-vs-host disease]]
==Diagnosis==
*[[Stem cell transplant complications]]
 
*[[Kidney transplant complications]]
==Management==
*[[Liver transplant complications]]
 
*[[Heart transplant complications]]
==Disposition==
*[[Lung transplant complications]]
*[[Pancreas transplant complications]]
*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==
*[[Immunocompromised antibiotics]]


==External Links==
==External Links==
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<references/>
<references/>


[[Category:Surg]]
[[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.