EM Special 6: Transplant Patient

Question 1

What is the most commonly transplanted organ?

Answer 1

Kidney (58%)

Liver(21%)
Heart (8%)
Lung (5%)
Pancreas (5%)

Question 2

What is the most common acute disorder in transplant patients prompting ED visit?

Answer 2

1. Infection (39%)
2. Non-infectious GI/GU pathology (15%)
3. Dehydration (15%)
4. MEI (10%)
5. Cardiopulmonary pathology/injury (10%/8%)
6. Rejection (6%)

Question 3

In transplant patients Varicella zoster virus can cause?

Answer 3

Pancreatitis

Question 4

Graft tenderness and swelling are usually seen in?

Answer 4

Acute rejection

Question 5

Often overlooked source of infection in transplant patients

Answer 5

Perirectal abscess

Question 6

Most common reason for ED visit by a transplant patient

Answer 6

Fever

Question 7

Patients on these medications demonstrate DECREASED temperatures

Answer 7

1. Mycophenolate mofetil
2. Azathioprine

Question 8

Most common infections in transplant patients

Answer 8

Urinary tract infections (43%)

Pneumonia (23%)

Question 9

Define graft vs host disease

Answer 9

Major cause of morbidity and mortality

Affects 50% of allogenic HSCT patients; also occurs after small bowl or liver transplant

Caused by Donated T Cells attacking on host cells

Question 10

A patient comes in 6 days after hematopoietic stem cell transplant with fever, generalized erythroderma, jaundice, and fluid retention. What do you consider?

Answer 10

Hyperacute graft vs host disease

+severe hepatitis, wide spread inflammation, shock

Question 11

Define Acute graft vs host disease

Answer 11

Appearance of disease up to 100 days after transplant

Involvement of 3 different systems: Skin (rash), GI (diarrhea, GI bleeding), Liver (jaundice, hepatitis)

Question 12

Most common symptom in acute graft vs host disease

Answer 12

Non specific rash

2nd most common - diarrhea

Question 13

Most widely used graft vs host prophylaxis

Answer 13

Cacineurin inhibitor (cyclosporine, tacrolimus) + Methorexate

Question 14

Define Chronic graft-vs-host disease

Answer 14

Late complication

immune dysregulation >100 days after transplant

Question 15

Risk factors for chronic graft vs host disease

Answer 15

1. older age
2. CMV seropositivity
3. Male who received stem cell transplant from a multiparous woman

Question 16

Typical rash in acute graft vs host disease

Answer 16

Maculopapular, brownish hue, Slight scaling

pruritic and painful

often on palms and soles initially then progresses to cheek, ears, neck, trunk, chest, upper back

Question 17

Immunosuppresion in acute graft vs host disease dose

Answer 17

PO Prednisone or IV Methylprednisolone 1-2mg/kg daily

Question 18

Hyperacute transplant rejection

Answer 18

mins to hours

due to preexisting antibodies

Question 19

Acute transplant rejection

Answer 19

first 6 months

acute cellular rejection or humoral rejection

Question 20

Chronic transplant rejection

Answer 20

Months to years after transplant

antibody and cell mediated rejection

Question 21

True or False:
The recepient’s SA node is preserved in cardiac transplantation

Answer 21

True

ECG frequently will have 2 distinct P waves often mistaken for a 2nd deg heart block, afib, flutter, PAC

Question 22

Time course of Lung Transplant:
0-3 days

Answer 22

Hemorrhage from technical/mechanical problems

Reperfusion injury

Dysrhythmia