The Emergency Medicine Approach to Transplant Complications

• Published in: The American journal of emergency medicine 2016-11, Vol.34 (11), p.2200-2208
• Main Authors: Long, Brit, MD, Koyfman, Alex, MD
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - adverse effects; Anemia; Biopsy; Diarrhea; Edema; Electrolytes; Emergency; Emergency medical care; Fever; Graft Rejection - etiology; Heart Transplantation - adverse effects; Humans; Hypertension; Immune system; Immunoglobulins; Immunosuppression - adverse effects; Immunosuppressive Agents - adverse effects; Infections - etiology; Kidney transplantation; Kidney Transplantation - adverse effects; Liver Transplantation - adverse effects; Lung Transplantation - adverse effects; Metabolic disorders; Mortality; Nosocomial infection; Nosocomial infections; Organ Transplantation - adverse effects; Pain; Patients; Quality of life; Renal function; Side effects; Signal transduction; Transplants & implants
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.08.049

ABSTRACT Introduction Organ transplantation provides improved quality of life and longevity in patients with end-organ disease. These patients have significant physiological and anatomical modifications, and with new immunosuppressive agents, many of these patients will present to the emergency department (ED) with complications. Objective To provide emergency physicians with a review of transplant complications, including infection, rejection, medication side effects, and specific complications related to the transplant. Discussion Transplant patients present significant challenges due to a large spectrum of complications that may arise. Infection is the most common complication and can be separated into different periods. The first month after transplant is associated with nosocomial and surgical infections, one month to six months after transplant with opportunistic infection, and greater than six months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication side effects due to immunosuppressive agents are common and include renal dysfunction, anemia, metabolic syndrome, and gastrointestinal effects. Renal transplant dysfunction includes vascular complications, hematoma, obstruction, and lymphocele. Liver transplant complications include vascular defects, biliary tract malfunctions, and fluid collections. Heart transplant complications manifest with vasculopathy and dysrhythmia. Lung transplant complications include airway dysfunction, phrenic nerve dysfunction, and pleural fluid collections. All transplant patients in the ED require close communication with the transplant physician and emergency provider. Conclusions Transplant patients can present significant challenges to the emergency provider. Knowledge of these complications may improve patient care. All cases require contact with the transplant physician.