Evaluation of Orthotopic Liver Transplant Recipients Presenting to the Emergency Department

Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Introduction and objectives Liver transplantation and its indications represent an increased burden on patients' health. This can be represented in a variety of ways, such as in emergency visits, unscheduled clinic visits, and unanticipated admissions. This study aims to analyze emergency department (ED) visits, the most common presenting complaints, and the outcomes of those visits. Methods A retrospective observational study was performed in which electronic medical records were reviewed for all patients who underwent liver transplantation and presented to the emergency department between October 2011 and October 2021. The following data were collected: demographics, comorbidities, liver transplant features, and emergency department visit data and outcomes. Recurrent visits were assessed and labeled as first, second, third, fourth, and fifth or more. Results A total of 699 patients and 5,225 visits were included in the analysis. Living donors accounted for 80% of all transplants. The mean post-operative length of stay was 22.6 ± 17.8. The majority of patients (74%) had at least one comorbidity, with diabetes (47%), hypertension (31%), and chronic kidney disease (CKD) (16%) being the commonest comorbidities; however, comorbidities were not associated with an increased risk of emergency department visits. Out of the 5,225 visits to the emergency department, 2,265 (41%) were within the first year. Emergency department visits in the first seven days after discharge amounted to 22% of total first visits. By 30 days, six months, and one year, they increased to 46%, 83%, and 91%, respectively. Living donor recipients had an average of 7.3 ED visits as compared to deceased donor recipients, who had an average of 8.4 ED visits. The most common presenting complaints were gastrointestinal (GI) symptoms (18%), infectious disease symptoms (9%), and respiratory symptoms (8%). There were a total of 296 patients who were readmitted at least once since discharge after liver transplantation. Conclusion The majority of first-time presentations to ED occurred in the first year post-transplant, marking this time period as critical for liver transplant patients. Our study also highlighted the continual presentations of liver transplant patients to the ED a few years post-transplant. This requires close scrutiny of the main causes of such presentations as well as comparison with other transplant cases to identify whether they are specific to liver transplants or not.

Reducing Hospital Readmissions via Optimization of Emergency Department Care

Over the past 5 years, early hospital readmissions have become a national focus. With several recent publications highlighting the high rates of early hospital readmissions among transplant recipients, more work is needed to identify risk factors and strategies for reducing unnecessary readmissions among this patient population. Although the American Society of Transplant Surgeons is advocating the exclusion of transplant recipients from the calculation of hospital readmission rates, the outcome of their advocacy efforts remains uncertain. One potential strategy for reducing early hospital readmissions is to critically examine care received by transplant recipients in the emergency department (ED), a critical pathway to readmission. As a starting point, research is needed to assess rates of ED presentation among transplant recipients, diagnostic algorithms, and communication among clinical teams. Mixed-methods studies that enhance understanding of system-level barriers to optimized evaluation and treatment of transplant recipients in the ED may lead to quality improvement interventions that reduce unnecessary readmissions, even if the rates of transplant recipients presenting to the ED remains high.

Diabetic ketoacidosis in a child on FK506 immunosuppression after a liver transplant

The use of immunosuppressive agents is becoming more widespread, especially in the context of organ transplantation. We report a child with a complication, new-onset diabetes mellitus with diabetic ketoacidosis, associated with the use of one such agent, FK506 (tacrolimus).

A descriptive analysis of 290 liver transplant patient visits to an emergency department

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. Eighty-four 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.