The emergency medicine approach to transplant complications

Brit Long, Alex Koyfman

Research output: Contribution to journalReview article

3 Citations (Scopus)

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 with complications. Objective The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse 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, 1 month to 6 months after transplant with opportunistic infection, and greater than 6 months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication adverse 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 emergency department 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.

Original languageEnglish (US)
Pages (from-to)2200-2208
Number of pages9
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Emergency Medicine
Transplants
Emergencies
Immunosuppressive Agents
Physicians
Blood Vessels
Hospital Emergency Service
Infection
Lymphocele
Kidney
Phrenic Nerve
Opportunistic Infections
Biliary Tract
Organ Transplantation
Cross Infection
Hematoma
Anemia
Patient Care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The emergency medicine approach to transplant complications. / Long, Brit; Koyfman, Alex.

In: American Journal of Emergency Medicine, Vol. 34, No. 11, 01.11.2016, p. 2200-2208.

Research output: Contribution to journalReview article

@article{e0a58b2ee75540c4a5dd04663ecaae7e,
title = "The emergency medicine approach to transplant complications",
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 with complications. Objective The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse 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, 1 month to 6 months after transplant with opportunistic infection, and greater than 6 months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication adverse 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 emergency department 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.",
author = "Brit Long and Alex Koyfman",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.ajem.2016.08.049",
language = "English (US)",
volume = "34",
pages = "2200--2208",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - The emergency medicine approach to transplant complications

AU - Long, Brit

AU - Koyfman, Alex

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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 with complications. Objective The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse 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, 1 month to 6 months after transplant with opportunistic infection, and greater than 6 months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication adverse 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 emergency department 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.

AB - 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 with complications. Objective The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse 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, 1 month to 6 months after transplant with opportunistic infection, and greater than 6 months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication adverse 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 emergency department 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.

UR - http://www.scopus.com/inward/record.url?scp=84994131137&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994131137&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2016.08.049

DO - 10.1016/j.ajem.2016.08.049

M3 - Review article

C2 - 27645810

AN - SCOPUS:84994131137

VL - 34

SP - 2200

EP - 2208

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 11

ER -