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Management of patients with transplanted organs in the emergency department (ED) involves three general areas: (1) disorders specific to certain transplanted organs, (2) disorders common to many different kinds of transplant patients due to an immunosuppressed state or antirejection medications, and (3) disorders not specifically related to a transplanted organ but where special care may be warranted due to associated medications or altered physiology. Disorders specific to the transplanted organ are manifestations of acute rejection, surgical complications specific to the procedure performed, and altered physiology (most important in cardiac transplantation). The most common conditions that prompt transplant patients to present to the ED are infections (39%), noninfectious gastrointestinal (GI) or genitourinary pathology (15%), dehydration (15%), electrolyte disturbances (10%), cardiopulmonary pathology (10%) or injury (8%), and rejection (6%).


Posttransplant infections are the most common presenting diagnosis to the ED for this patient population, in part due to the ongoing immunosuppression required for transplant recipients. Additional infection risk factors include diabetes mellitus, advanced age, obesity, and other host factors. Table 99–1 lists the broad array of potential infections and the time after transplant they are most likely to occur.

Table 99-1

Infections Stratified by Posttransplant Period

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