Organ transplant patients in the emergency department

Abstract

Background: Patients after solid organ transplantation represent a special collective in the emergency department. Atypical symptoms as well as complex concomitant factors often pose special challenges to the practitioners. Objectives: Characterization of organ transplant patients in the emergency department with regard to their reasons for presenting and analysis of differences between transplant organs. Materials and methods: Retrospective descriptive analysis of patients after solid organ transplantation who presented to the Hannover Medical School emergency department within 2 years. Data collected included sociodemographic characteristics, presenting complaints (Canadian Emergency Department Information System, CEDIS), and discharge diagnoses. Results: During the study period, 977 presentations of organ transplant patients were registered in the emergency department. The presenting complaint most often registered was fever (23.6%), followed by general weakness (19.2%), and abdominal pain (17.0%). The most common diagnosis was acute infection (43.8%), followed by graft failure (19.3%). In the subgroup with acute infections, the primary focus was the urinary tract in kidney transplant patients (NTx), the biliary tract in liver transplant patients (LTx), and the respiratory tract in lung transplant patients (LuTx). In the graft failure subgroup, graft failure due to infection was shown to predominate in NTx patients, while immunologic rejection predominated in LTx and LuTx patients. Conclusion: Fever and acute weakness are common but nonspecific complaints leading to the presentation of organ transplant patients to the emergency department. In many cases, these are due to infection or acute graft failure.