Management of Renal Transplant Patients in the Emergency Department

Abstract

Solid organ transplant patients constitute a special population in the emergency departments (EDs). Increasing numbers of patients are reported in EDs for transplantation-related complications. Complications related to organ transplantation can be categorized into four groups: anatomical, infection, rejection, and drug toxicity. In patients presenting to the ED, all these categories should be considered in the differential diagnosis. However, the exact etiology, may not be known until admission to the hospital for further evaluation. Therefore, every complaint from a transplant patient should be carefully evaluated. In this study, we will review the principles for the management of patients with renal transplantation in the ED. (JAEM 2015; 14: 83-7) Keywords: Renal failure, transplantation, emergency care IntroductionOrgan transplantation is one of the most significant achievements in medicine for treating patients with end-stage organ failure. As a result of its success, increasing numbers of patients are reported in the emergency departments (EDs) for transplantation-related complications. Solid organ transplant patients constitute a special population in the ED. In this study, we will review the principles for the management of patients with renal transplantation in the ED.The transplanted kidney lacks the native nerve innervations of its donor, and it is connected to multiple organs with surgical anastomosis. As a result, pain is an unreliable indication of the underlying pathology. Furthermore, it is important to consider the anatomical association of the transplanted organ in order to understand leaks and blockages that can occur at the sites of anastomosis. Vague signs and symptoms may develop as a result of inflammation and immunological responses to infection and malignancy. Therefore, every complaint from a transplant patient should be carefully evaluated. When major complaints are present, knowledge of the initial physiological condition of the allograft can help to rule in or rule out possible organ failure. Even minor changes in allograft functioning can indicate organ failure. The duration of time since the organ transplantation should always be considered when evaluating the patient's condition (1-3). Complications of Renal TransplantationOrgan transplantation-related complications can be categorized into four groups: anatomical, infection, rejection, and drug toxicity. In patients presenting to the ED, all these categories should be considered in the differential diagnosis. However, the exact etiology, may not be known until admission to the hospital for further evaluation (1, 2). A. Complications Related to Transplantation TechniqueTransplantation technique-related complications can develop during the preparation for transplantation and during the surgery. They can be divided into early-and late-stage complications (2). Early-stage complicationsEarly-stage complications can develop immediately after the surgical procedure or during the early postoperative period. They include general ...

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“…To accomplish this goal, extensive laboratory tests and radiologic imaging modalities are needed. 2 One possible laboratory tests is CRP, a reportedly sensitive indicator of systemic inflammatory response. 6 However, its level has been reported to be affected by several factors, including malignancy, sex, and age.…”