Transplant complications

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)
    • 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

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.