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 [1]
Immunosuppressant Medications
- Balance between immune suppression, rejection and susceptibility to infection
- Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
- Calcineurin inhibitor
- Steroids
- +/- Antimetabolite
Infections[2]
Time from transplantation affects the risk and type of infection.
- Early (within the first month)
- Donor-derived - bacterial, fungal, parasitic
- Nosocomial & surgical-site - C. diff, aspiration Pneumonia, UTI, surgical-site, superinfection of graft tissue
- Intermediate (1-6 months after)
- Highest risk for opportunistic infections - PCP, TB, fungal (cryptococcus, histoplasma), viral (BK virus, hepatitis B/C, CMV)
- Dormant host infection reactivation - HSV, VZV, EBV
- Late (more than 6 months after)
- Community-acquired infection
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