- The most common presenting complaint by the transplant patient is fever. This can be due to infection in an immune compromised state, or to graft rejection.
- A febrile transplant patient should be carefully assessed for early signs of shock.
- Commonly used calcineurin inhibitors (e.g., tacrolimus) can place a transplant patient at risk for nephrotoxicity.
- Drugs commonly prescribed in the ED can interfere with the metabolism of potent immunosuppressive medications, causing adverse drug–drug interactions in transplant patients.
Over the past 10 years, the number of transplant recipients in the United States has increased from almost 20,000 to nearly 30,000 per year and the corresponding number in pediatric transplantation has also grown dramatically.1 This increase has also accompanied improved outcomes and survival rates largely because of improved surgical techniques and immunosuppression drug regimens.2–6 From a historical perspective, the developments in the field have been dramatic. A brief time line is given in Table 19–1 describing key milestones.
Table 19-1. Advances in Transplant Medicine |Favorite Table|Download (.pdf)
Table 19-1. Advances in Transplant Medicine
Dr. Joseph Murray at Peter Bent Brigham Hospital, Boston performs first successful twin to twin kidney transplant
Dr. E. Donnall Thomas at Colombia University affiliated hospital, Cooperstown, New York, performs first bone marrow transplant using related donor
Dr. Thomas Starzl at the University of Colorado Health Sciences Center, Denver, performs first successful liver transplant
Dr. Christiaan Barnard at Groote Schur Hospital, Cape Town, South Africa, performs first successful heart transplant
Introduction of antirejection drug azathioprine
Dr. David Sutherland at the University of Minnesota, Minneapolis, performs first living-related pancreas transplant
Dr. Bruce Reitz at Stanford University, California, performs first successful heart–lung transplant
U.S. FDA approves use of cyclosporine as an immunosuppressant drug
Dr. David Grant at the University Hospital of London Health Sciences Centre, London, Ontario, performs first successful liver–bowel transplant
Tacrolimus (FK 506) becomes available as an immunosuppressant drug
U.S. FDA approves use of mycophenolate mofetil to prevent organ rejection in kidney transplants
Physicians at the University of Miami, Florida, perform first transplantation of all abdominal organs in a single patient
Physicians at Emory University, Atlanta, perform first unrelated stem cell transplant
U.S. FDA approves use of sirolimus to prevent organ rejection in adult renal transplant patients
As advances in transplant medicine progress, more and more transplant patients will present to the emergency department (ED) and the pediatric emergency medicine provider should remain aware of the complexities involved in the care of the transplant patient. This includes an understanding of the usual presenting signs and symptoms, the common complications as well as the common medications used for immunosuppression, and their interactions.
The majority of transplant patients will likely require hospitalization sometime during the first 6 months after transplant. Some of the common reasons for presentation are fever, ...