A Descriptive Analysis of 290 Liver Transplant Patient Visits to an Emergency Department

Abstract

Abstract. Objective: To provide a descriptive analysis of emergency department (ED) presentations and management of orthotopic liver transplant (OLT) patients. Methods: A retrospective chart review was performed of OLT patients presenting to the University of California at Los Angeles (UCLA) ED during 1995. The sole inclusion criterion was receiving an OLT within three years prior to the ED visit. Data describing chief complaint(s), history of present illness, physical findings, laboratory results, imaging studies, and final diagnoses were collected. Results: One hundred forty-three patients accounted for a total of 290 ED visits. The patients had a mean age of 37 years (range 3 months to 74 years) and presented at mean post-OLT duration of 9 months (range 2 weeks to 34 months). There were 660 presenting complaints, of which abdominal (39%), fever (17%), respiratory (13%), and neurologic (11%) symptoms were the most common. There were 478 final diagnoses, of which abdominal (27%), infectious (24%), and metabolic (11%) disorders were the most common. Eightyfour percent of ED visits resulted in extensive diagnostic testing and 69% resulted in hospitalization. Conclusions: Serious illnesses with nonspecific presentations were frequently encountered in this study population. These factors resulted in a majority of the patients' undergoing extensive diagnostic evaluations and being hospitalized. Key words: liver transplant; emergency complications; transplantation. ACA-DEMIC EMERGENCY MEDICINE 2000; 7:898-905 M ORE than 4,000 orthotopic liver transplants (OLTs) are performed annually at more than 100 facilities in the United States.1,2 At the UCLA Medical Center alone, 726 OLTs were performed from January 1993 through December 1995. Improvements in harvest and surgical techniques, immunosuppression, and medical management of OLT patients have resulted in five-year survival rates approaching 80%.3-5 Consequently, the number of OLT patients presenting to emergency departments (EDs) is rising. While numerous studies have described the postoperative complications seen in OLT patients, none have specifically addressed the reasons why OLT patients present to the ED. [6][7][8][9][10][11][12][13] The objective of this study was to provide a descriptive analysis of the ED presentations and management of OLT recipients. METHODSStudy Design. We conducted a chart review of all OLT patient visits to the UCLA Emergency Medical Center during the calendar year 1995. Because of its retrospective nature, this study was considered exempt from informed consent after institutional review board review.Study Setting and Population. The Emergency Medical Center is the ED for the UCLA Medical Center, a 600-bed university teaching hospital, and has an annual census of 38,000 visits. The only inclusion criterion for the study was receiving an OLT within three years prior to the date of the ED visit.Study Protocol. A list of all OLT visits to the ED was obtained from a registry the liver transplant service maintains of all OLT patient encounte...

Children after renal transplantation hospitalized for fever: Is empirical antibiotic treatment always justified?

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Early Postoperative Emergency Department Care of Abdominal Transplant Recipients

“…These findings are similar to prior studies of transplant recipients, which showed high rates of ED visits as well as ED-related readmissions. (1–5) However, the ED visit and hospital readmission rates are higher than reported for pre-MELD transplant cohorts, as well as for other complex surgical patients, such as those undergoing vascular, cardiac, and oncologic surgeries. (11) This may be explained in part by the increasing medical complexity of transplant recipients over the past decade.…”

“…It is possible that transplant recipients who present to the ED do so at the suggestion of transplant clinicians over the phone or following an in-person evaluation, and determining precise reasons for ED presentation will require qualitative analysis. (1) In addition, prior retrospective reviews have demonstrated a low incidence of preventable readmissions among kidney transplant recipients, suggesting that improvement in this aspect of post-transplant care may benefit from focus on improving clinical care algorithms and processes rather than seeking overall avoidance of ED visits. (16) Efforts to reduce short (<24 hour) admissions following ED visits have led to the inclusion of this data point in the transplant division quality improvement strategy.…”

“…These factors may contribute to the significant number of transplant recipients (heretofore referred to as recipients) who seek Emergency Department (ED) care. (1–5)…”

Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings

“…These patients come to the ED with a number of medical emergencies. 1 Infections are one them and most common causes of morbidity and mortality in transplant patients who are treated with immunosuppressive drugs. 2 In a transplant patient, fever may be the first and only sign and symptom of the infection.…”