Transplant patients are at risk for illnesses and complications days, months, or years after transplantation, and they can present complex challenges for emergency clinicians. This review discusses the general approach to the management of pediatric transplant patients in the emergency department, with a focus on general complications and organ-specific complications after solid organ transplantation. Hematopoietic stem cell transplantation and its common complications will also be discussed. A key step in the management of all transplant patients includes consultation with the patient’s transplant team to ensure appropriate testing, treatment, and disposition for these patients.
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Following are the most informative references cited in this paper, as determined by the authors.
1. U.S. Department of Health & Human Services. National Data: Organ Procurement and Transplantation Network. Accessed September 15, 2021. (National database)
7. * Zhong D, Liang SY. Approach to transplant infectious diseases in the emergency department. Emerg Med Clin North Am. 2018;36(4):811-822. (Review article) DOI: 10.1016/j.emc.2018.06.010
9. * Sanchez-Fueyo A, Strom TB. Immunologic basis of graft rejection and tolerance following transplantation of liver or other solid organs. Gastroenterology. 2011;140(1):51-64. (Review article) DOI: 10.1053/j.gastro.2010.10.059
17. * Weigel F, Lemke A, Tonshoff B, et al. Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study. Pediatr Nephrol. 2016;31(6):1021-1028. (Prospective study; 137 patients) DOI: 10.1007/s00467-015-3292-2
25. * Joong A KA. Emergency department evaluation of the pediatric heart transplant recipient. Clin Pediatr Emerg Med. 2018;19(4):353-357. (Review article) DOI: 10.1016/j.cpem.2018.12.006
32. * Faro A, Mallory GB, Visner GA, et al. American Society of Transplantation executive summary on pediatric lung transplantation. Am J Transplant. 2007;7(2):285-292. (Review article) DOI: 10.1111/j.1600-6143.2006.01612.x
36. * Fraint E, Holuba MJ, Wray L. Pediatric hematopoietic stem cell transplant. Pediatr Rev. 2020;41(11):609-611. (Review article) DOI: 10.1542/pir.2020-0130
44. * Dulek DE, de St Maurice A, Halasa NB. Vaccines in pediatric transplant recipients-past, present, and future. Pediatr Transplant. 2018;22(7):e13282. (Review article) DOI: 10.1111/petr.13282
47. * Blondet NM, Healey PJ, Hsu E. Immunosuppression in the pediatric transplant recipient. Semin Pediatr Surg. 2017;26(4):193-198. (Review article) DOI: 10.1053/j.sempedsurg.2017.07.009
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Keywords: transplant patients, pediatric transplant patients, posttransplant patients, posttransplantation, complications after transplantation, complications after transplant, organ transplantation, solid organ transplantation, hematopoietic stem cell transplantation, HSCT, infection, rejection, hyperacute rejection, acute rejection, chronic rejection, medication adverse effects, graft-versus-host disease, GVHD, acute graft-versus-host disease, acute GVHD, chronic graft-versus-host disease, chronic GVHD, kidney transplant, heart transplant, liver transplant, lung transplant, immunosuppression, immunosuppressive medications, transplant infection, vaccines transplant patient, cytomegalovirus infection, CMV, Epstein-Barr virus infection, EBV, BK virus, posttransplant lymphoproliferative disorder, PTLD, hepatic artery thrombosis, HAT, portal vein thrombosis, PVT
Brittany DiFabio, MD, FAAP; Timothy Ruttan, MD, FACEP, FAAP
Jennifer Bellis, MD, MPH; David M. Rodriguez, MD, FAAP
October 2, 2021
November 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits.
Date of Original Release: October 1, 2021. Date of most recent review: September 15, 2021. Termination date: October 1, 2024.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credit, subject to your state and institutional requirements.
ACEP Accreditation: Pediatric Emergency Medicine Practice is also approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAP Accreditation: This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 48 AAP credits per year. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Fellows of the American Academy of Pediatrics.
AOA Accreditation: Pediatric Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.
Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for emergency physicians.
Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
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Commercial Support: This issue of Pediatric Emergency Medicine Practice did not receive any commercial support.
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Cover Image: Xie B-Q, Wang W, Zhang W-Q, Guo X-H, Yang M-F, Wang L, et al. (2014) Ventilation/Perfusion Scintigraphy in Children with Post-Infectious Bronchiolitis Obliterans: A Pilot Study. PLoS ONE 9(5): e98381. DOI: 10.1371/journal.pone.0098381 Used under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Adapted by adding color.