Difference between revisions of "Transplant complications"
ClaireLewis (talk | contribs) (→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) | + | *Transplanted (solid) organ frequency: kidney > liver > heart > lung > pancreas > other (combined and intestines) |
| − | *Most transplant | + | *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 |
| − | ** | ||
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===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> | ||
| − | + | {{Immunosuppressant medication complications}} | |
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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>=== |
| + | 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 | ||
| − | == | + | ==Types== |
| − | + | *[[Graft-vs-host disease]] | |
| − | + | *[[Stem cell transplant complications]] | |
| − | + | *[[Kidney transplant complications]] | |
| − | + | *[[Liver transplant complications]] | |
| − | + | *[[Heart transplant complications]] | |
| − | + | *[[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: | + | [[Category:Surgery]] |
[[Category:Misc/General]] | [[Category:Misc/General]] | ||
Latest revision as of 02:36, 23 August 2019
Contents
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
- Balance between immune suppression, rejection and susceptibility to infection
- Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
- Calcineurin inhibitor
- Steroids
- +/- Antimetabolite
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)
- Highest risk for opportunistic infections - PCP, TB, fungal (cryptococcus, histoplasma), viral (BK virus, hepatitis B/C, CMV)
- Dormant host infection reactivation - HSV, VZV, EBV
- Late (more than 6 months after)
- Community-acquired infection
Types
- Graft-vs-host disease
- Stem cell transplant complications
- Kidney transplant complications
- Liver transplant complications
- Heart transplant complications
- 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