Outcomes of patients coming to the emergency department after kidney transplantation

Yıl 2022, Cilt: 5 Sayı: 2, 499 - 503, 15.03.2022

Nezih Kavak Mehmet Altan

https://doi.org/10.32322/jhsm.1054011

Öz

Introduction: In kidney transplantation (KT) practice, improvements in patient care led to increased graft and patient survival. This study aimed to determine the symptomatology of KT patients presenting to emergency department (ED), their final diagnoses, and outcomes.
Material and Method: Data including demographic data (age and gender), chief complaints (CCs), number of ED presentations, ED presentation date, KT date, donor type (live/deceased), patient disposition (discharge/admission), final diagnosis, and outcomes (acute renal graft dysfunction/graft loss/death) were retrieved and analyzed.
Results: Twenty-five KT patients presented to ED during the study period. These patients presented to ED for 46 times with 50 CCs. Fever was the most frequent CC (20%). The ED presentation led to a final diagnosis of infection in 32 presentations (69.4%). The most frequent infection was urinary tract infection (UTI) (26.1%) followed, by acute gastroenteritis (17.4%) and upper respiratory tract infection (17.4%). Acute graft dysfunction was the most common “non-infectious diagnosis” (17.4%) followed by cardiovascular disease (8.5%). The ED presentation led to admission in 32.6% (15/46) of the cases. Among 15 admissions, 7 (46.7%) were due to UTI. No rejections, graft loss, or mortality occurred following any ED presentations.
Conclusion: When evaluating KT patients in the ED, physcians should bear in mind that they could have an infectious pathology that is often associated by fever, also they should check for acute graft dysfunction and cardiac pathologies.

Anahtar Kelimeler

Emergency, kidney, transplantation

Kaynakça

• Collins AJ, Foley RN, Herzog C, et al. Excerpts from the US Renal Data System 2009 Annual Data Report. Am J Kidney Dis 2010; 55: S1-420, A6-7.
• Cimen SG, Oğuz E, Gundogmus AG, Cimen S, Sandikci F, Ayli MD. Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial. World J Transplant 2020; 29: 79-89.
• Kartal M GE, Eray O, Gungor F. Factors affecting to hospital admission for renal transplant patients in the emergency department. Turk J Emerg Med 2009; 9: 159–62.
• Venkat KK, Venkat A. Care of the renal transplant recipient in the emergency department. Ann Emerg Med 2004; 44: 330-41.
• Bardaxoglou E, Maddern G, Ruso L, et al. Gastrointestinal surgical emergencies following kidney transplantation. Transpl Int 1993; 6: 148-52.
• Uysal E, Dokur M, Bakir H, Ikidag MA, Kirdak T, Kazimoglu H. the reasons of renal transplant recipients' admission to the emergency department; a case series study. Emerg (Tehran) 2016; 4: 207-10.
• Tokalak I, Başaran O, Emiroğlu R, Karakayali H, Bilgin N, Haberal M. Problems in postoperative renal transplant recipients who present to the emergency unit: experience at one center. Transplant Proc 2004;36:184-6.
• Trzeciak S, Sharer R, Piper D, et al. Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 2004; 22: 530-3.
• Heaf JG. Bone disease after renal transplantation. Transplantation. 2003; 75: 315-25.
• Grimaldi A, Barletta A, Rascente M, et al. Infectious complications in the renal transplant recipient. Transplant Proc 2005; 37: 2502-3.
• Koo EH, Jang HR, Lee JE, et al. The impact of early and late acute rejection on graft survival in renal transplantation. Kidney Res Clin Pract 2015; 34: 160-4.
• Schmaldienst S, Dittrich E, Hörl WH. Urinary tract infections after renal transplantation. Curr Opin Urol 2002; 12: 125-30.
• Becker S, Witzke O, Rübben H,et al. Harnwegsinfektionen nach Nierentransplantation: Essener Algorithmus zur kalkulierten Antibiotikatherapie [Urinary tract infections after kidney transplantation: Essen algorithm for calculated antibiotic treatment] Urologe A 2011; 50: 53-6.
• Unterman S, Zimmerman M, Tyo C, et al. A descriptive analysis of 1251 solid organ transplant visits to the emergency department. West J Emerg Med 2009; 10: 48-54.
• McElroy LM, Schmidt KA, Richards CT, et al. Early postoperative emergency department care of abdominal transplant recipients. Transplantation 2015; 99: 1652-7.
• Schold JD, Elfadawy N, Buccini LD, et al. Emergency department visits after kidney transplantation. Clin J Am Soc Nephrol 2016; 11: 674-83.
• Li AH, Lam NN, Naylor KL, et al. Early hospital readmissions after transplantation: burden, causes, and consequences. Transplantation 2016; 100: 713-8.
• Okidi OO, Van Dellen D, Sobajo C, et al. Kidney transplant recipients requiring critical care admission within one year of transplant. Exp Clin Transplant 2017; 15: 40-6.
• Weeda ER, Su Z, Taber DJ, et al. Hospital admissions and emergency department visits among kidney transplant recipients. Clin Transplant 2019; 33: e13522.
• Lovasik BP, Zhang R, Hockenberry JM, et al. Emergency department use among kidney transplant recipients in the United States. Am J Transplant 2018; 18: 868-80.