0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

There are three categories of transplant rejection: Hyperacute, acute, and chronic.

■ Hyperacute: Occurs from a few minutes to hours after surgery and results

in irreversible graft destruction

■ Acute: Generally occurs 1–12 weeks after transplant and may be reversed

■ Chronic: Progressive, insidious decline results in tissue fibrosis, ischemia,

and death; no effective therapy

Renal Transplant

SYMPTOMS/EXAM

■ Tenderness over allograft (in the left or right iliac fossa)

■ Decreased urine output, increased edema, and weight gain

■ Elevated serum creatinine

■ Worsening hypertension

DIFFERENTIAL

■ Volume contraction, cyclosporine nephrotoxicity

DIAGNOSIS

■ UA, chemistries, renal ultrasound, cyclosporine level

TREATMENT

■ Methylprednisolone, 500 mg IV

Lung Transplant

SYMPTOMS/EXAM

■ Cough, dyspnea

■ Chest tightness

■ Fever (>0.5 degrees C above baseline)

DIFFERENTIAL

■ Infection

DIAGNOSIS

■ CXR, ABG, spirometry, drug levels

TREATMENT

■ Methylpredisolone, 500 mg–1 g IV

Heart Transplant

SYMPTOMS/EXAM

■ Patient may be asymptomatic or complain of generalized fatigue.

■ Heart failure: Orthopnea, JVD, PND

■ Dysrhythmias

DIAGNOSIS

■ ECG, cardiac enzymes

Complications in transplant

patients:

Rejection

Infection

Immunosuppressant drug

toxicity

A subtle rise in creatinine may

be the only indication of acute

rejection of a transplanted

kidney.

Findings on CXR for acute lung

rejection are usually

nonspecific and may include

perihilar infiltrates, interstitial

edema, pleural effusions.