Transplant patients are chronically immunosuppressed, attempting to balance between underimmunosuppression, with the risk of graft rejection, and overimmunosuppression, with the risk of infection. When these patients present to the emergency department with fever, increasing edema, decreased urine output, graft pain or swelling, or increasing fatigue, they should be evaluated for infection and renal graft function. These patients are complex, and it is often difficult to determine on initial assessment the presence of a serious infection or complication. It is recommended that the patient's physician or transplant coordinator be consulted to help the emergency physician in making the disposition decision.
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