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Transplant Emergencies - Dr. Goldonowicz

Rejection

• Hyperacute - w/in minutes - we won't see
• Acute
• Chronic

Anatomy

• Vascular - stenosis, aneurysm, thrombosis
• Nonvascular - leak, scar formation, dislodged stint, stone formation

Infection

• First 28 days - nosocomial
• 1-6 months - viral infections - CMV, hepatitis, EBV, HH6; oppurtunisitcs - PCP, listeria, fungal
• > 6 months - Healthy - UTI, PNA, cold, Chronic viral infection - EBV, zoster, HSV

Drug Toxicity

• Transplant immunosuppressants - cyclosprine,…

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Featured

 Transplant Emergencies Part I: Infection, Rejection, and Medication Effects

These patients can be challenging to manage, as they are on immunosuppressive medications and have significant anatomic and physiologic variations.3-5 Transplant patients may develop a significant number of complications including infection, medication effects, rejection, and specific complications related to the transplanted organ.

 Transplant Emergencies Part II: Organ Specific Complications

This is part II of a series detailing transplant emergencies. Part I covered transplant infection, rejection and medication side effects. We will evaluate renal, cardiac, liver, and lung transplant complications in this post.

 Transplant Medicine in the ED

This review summarizes the physiology of transplant and a few of the key issues to be aware of in these patients.

Articles of Interest

Fear of Rejection: Managing the Transplant Patient in the ED

These patients can be challenging to manage, as they are on immunosuppressive medications and have significant anatomic and physiologic variations

Management of Pediatric Transplant Patients in the Emergency Department

This review discusses the general approach to the management of pediatric transplant patients in the emergency department, with a focus on general complications and organ-specific complications after solid organ transplantation. Hematopoietic stem cell transplantation and its common complications will also be discussed.

Managing renal transplant complications

Rejection is the only unique cause for renal failure in kidney transplant patients. Two common causes of acute renal failure are acute cyclosporine or tacrolimus nephrotoxicity and acute rejection.

Transplant Emergencies and Their Management

Fever can be a sign of rejection, NOT always infection (Biopsy is typically needed).

Transplant “emergencies” AKA It's 3 a.m., why are you calling ...

The reasons why you will get called about transplant patients aren’t necessarily the same as the reasons why patients are evaluated in the ED.

Resources

Rush Emergency Medicine

Working in the ED of a hospital that performs transplants means that you see a lot of people that are pre-, post-, post-and-pre-again-transplant. We are very very lucky that the transplant teams at Rush are very involved and involved early. In fact we are so lucky that transplant surgeon Dr. Edie Chan, came and give us a talk. This post is in summary of some of the wisdom she imparted on us: focusing specifically on liver and kidney transplants.

WikEM

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.