title: Trauma patients with a previous organ transplant: outcomes are better than expected-a retrospective analysis.
abstract: BACKGROUND
  Few reports are available concerning outcomes following trauma in transplanted patients. Investigating outcomes for patients in this population may yield helpful information about both immunosuppression and inflammatory responses.
  
  
  METHODS
  This was a retrospective study. The trauma registry was used to identify all patients with a history of solid-organ transplant who were admitted to the trauma center between January 2007 and June 2011. Data were stratified by age, sex, Injury Severity Score (ISS), and length of stay (LOS).
  
  
  RESULTS
  During the study period, 50 patients admitted for traumatic injury also had previous organ transplants. We found that white blood cell count was significantly lower for transplanted patients (p < 0.001) and remained significantly lower at each stratification criteria. In addition, LOS was either lower or no different for transplanted patients when data were stratified. Only one patient explicitly had an injured graft (a kidney) secondary to trauma at the time of admission. This resulted in acute renal failure and a doubling of the serum creatinine. Three patients had questionable graft injuries, but graft function remained normal. Seventeen percent of patients developed acute rejection following admission for trauma.
  
  
  CONCLUSIONS
  Outcomes following injury in patients with previous organ transplant are not worse than outcomes for nontransplanted patients, and transplanted organs are infrequently injured. Prospective data are needed to understand better the balance of inflammatory and anti-inflammatory mediators following acute injury in this population.
  
  
  METHODS
  Therapeutic/care management, level III.
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, Maryland 21201, USA. jscalea@smail.umaryland.edu
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Scalea
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Adam K
authors.initials: AK
authors.lastname: Meeks
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kramer
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kufera
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Auman
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007249:Inflammation / Q000150:complications / Q000276:immunology; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries; D016030:Kidney Transplantation / Q000009:adverse effects; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy
chemical_list: D007166:Immunosuppressive Agents