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

Immunosuppressant Medications

• Balance between immune suppression, rejection and susceptibility to infection
• Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
  • Calcineurin inhibitor
    • Cyclosporine
    • Tacrolimus
  • Steroids
    • Prednisone/Prednisolone
  • +/- Antimetabolite
    • Azathioprine
    • Mycophenolate mofetil (MMF)

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

• Immunocompromised antibiotics

References

Authors

Melody Ong, Ross Donaldson, Claire, Amr Badawy, Michael O'Brien, MD, Catie Reynolds, Daniel Ostermayer