title: The emergency medicine approach to transplant complications.
abstract: BACKGROUND
  Organ transplantation provides improved quality of life and longevity in patients with end-organ disease. These patients have significant physiological and anatomical modifications, and with new immunosuppressive agents, many of these patients will present to the emergency department with complications.
  
  
  OBJECTIVE
  The objective was to provide emergency physicians with a review of transplant complications, including infection, rejection, medication adverse effects, and specific complications related to the transplant.
  
  
  CONCLUSIONS
  Transplant patients present significant challenges due to a large spectrum of complications that may arise. Infection is the most common complication and can be separated into different periods. The first month after transplant is associated with nosocomial and surgical infections, 1 month to 6 months after transplant with opportunistic infection, and greater than 6 months acquired infection. Rejection occurs in the hyperacute, acute, and chronic phases, with symptoms dependent on the specific organ. Medication adverse effects due to immunosuppressive agents are common and include renal dysfunction, anemia, metabolic syndrome, and gastrointestinal effects. Renal transplant dysfunction includes vascular complications, hematoma, obstruction, and lymphocele. Liver transplant complications include vascular defects, biliary tract malfunctions, and fluid collections. Heart transplant complications manifest with vasculopathy and dysrhythmia. Lung transplant complications include airway dysfunction, phrenic nerve dysfunction, and pleural fluid collections. All transplant patients in the emergency department require close communication with the transplant physician and emergency provider.
  
  
  CONCLUSIONS
  Transplant patients can present significant challenges to the emergency provider. Knowledge of these complications may improve patient care. All cases require contact with the transplant physician.
authors.affiliation: San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX, United States, 78234. Electronic address: brit.long@yahoo.com.
authors.forename: Brit
authors.initials: B
authors.lastname: Long
authors.affiliation: The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX, United States, 75390. Electronic address: akoyfman8@gmail.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D006084:Graft Rejection / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007239:Infections / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects; D016377:Organ Transplantation / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents