Introduction to the Transplant Patient

Liver and kidney transplant patients presenting to the emergency department with abdominal pain offer unique challenges in diagnosis and management. In addition to the usual abdominal pathologies, the emergency provider must consider unusual causes of pain that stem from anatomical complications related to the transplant procedure itself, the intended and adverse effects of the immunosuppressive medication regimen, and organ rejection. Infection is very common, but presentation can be subtle. The risk of infection due to drug-resistant bacteria, as well as viruses, fungi, and parasites, is much higher in this population. The timing of presentation in relation to the date of transplant is critical to determine as this influences the key considerations in the differential and guides antimicrobial therapy. Finally, early communication with the patient’s transplant team or surgeon is crucial to guide appropriate workup and disposition decisions.