A Narrative Review of the Evaluation and Management of Liver Transplant Complications in the Emergency Department

Sibai, Rayan El; Freedman, Sari R.; Gatz, J. David

doi:10.1016/j.jemermed.2023.02.022

Cited by 1 publication

(2 citation statements)

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“…A total of 10 articles within the existing body of literature on liver transplantation have specifically examined emergency visits. Among these works, two were review articles [ 6 , 11 ], while two others did not primarily focus on liver transplantation [ 12 , 13 ]. Thus, only six literary articles in all focused on emergency visits for liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

“…A major factor that adds to the difficulty of liver transplant is the need to allocate the scarce donated livers to the increasing number of patients in need of and likely to benefit from this procedure -the recently included groups of acute alcoholic hepatitis, intrahepatic cholangiocarcinoma, and colorectal metastasis patients [2], as well as the previously included groups of patients with decompensated cirrhosis due to hepatitis B, hepatitis C, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis [3]. Other factors that contribute to the complicated nature of liver transplantation include the need for lifelong immunotherapy [4], and the associated surgical and medical complications [5][6][7][8]. With the continual rise of cirrhosis worldwide [9], the demand for liver transplants is expected to rise, as will the need to address all associated factors and complications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Aljumaa,

AlShathri,

Aljumaa

et al. 2023

Cureus

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Introduction and objectives Liver transplantation and its indications represent an increased burden on patients' health. This can be represented in a variety of ways, such as in emergency visits, unscheduled clinic visits, and unanticipated admissions. This study aims to analyze emergency department (ED) visits, the most common presenting complaints, and the outcomes of those visits. Methods A retrospective observational study was performed in which electronic medical records were reviewed for all patients who underwent liver transplantation and presented to the emergency department between October 2011 and October 2021. The following data were collected: demographics, comorbidities, liver transplant features, and emergency department visit data and outcomes. Recurrent visits were assessed and labeled as first, second, third, fourth, and fifth or more. Results A total of 699 patients and 5,225 visits were included in the analysis. Living donors accounted for 80% of all transplants. The mean post-operative length of stay was 22.6 ± 17.8. The majority of patients (74%) had at least one comorbidity, with diabetes (47%), hypertension (31%), and chronic kidney disease (CKD) (16%) being the commonest comorbidities; however, comorbidities were not associated with an increased risk of emergency department visits. Out of the 5,225 visits to the emergency department, 2,265 (41%) were within the first year. Emergency department visits in the first seven days after discharge amounted to 22% of total first visits. By 30 days, six months, and one year, they increased to 46%, 83%, and 91%, respectively. Living donor recipients had an average of 7.3 ED visits as compared to deceased donor recipients, who had an average of 8.4 ED visits. The most common presenting complaints were gastrointestinal (GI) symptoms (18%), infectious disease symptoms (9%), and respiratory symptoms (8%). There were a total of 296 patients who were readmitted at least once since discharge after liver transplantation. Conclusion The majority of first-time presentations to ED occurred in the first year post-transplant, marking this time period as critical for liver transplant patients. Our study also highlighted the continual presentations of liver transplant patients to the ED a few years post-transplant. This requires close scrutiny of the main causes of such presentations as well as comparison with other transplant cases to identify whether they are specific to liver transplants or not.

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Section: Introductionmentioning

confidence: 99%