TABLE 4.
Summary of patient characteristics, and clinical course.
| Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
| Age | 68 | 64 | 54 | 64 |
| Gender | M | M | F | F |
| Race | CA | CA | CA | AA |
| Presenting Symptoms | Encephalopathy, fever, shock/PRESS | Asymptomatic | Confusion | Unable to assess as patient intubated for respiratory failure |
| Transplant indication | IPF | IPF | PE/PH | RA ILD/IPF |
| Transplant type | BL | BL | BL | BL |
| CMV Donor D/Recipient R | −/− | +/− | −/+ | +/− |
| EBV | I/+ | +/+ | +/+ | +/+ |
| Induction | B | B | B | B |
| Maintenance | MMF, MP, T | MMF, MP, T | MMF, MP, T | MMF, MP, T |
| Post Op complications | AMS/Sepsis/bleeding/MV/MOF | A fib, Left subclavian DVT | Primary graft dysfunction grade 3 | Trached but weaned, clam shell wound dehiscence |
| Wound dehiscence s/p debridement and wound vac placement | ||||
| — | — | — | ECMO | ECMO |
| Initial ammonia value a | 55 | 29 | 54 | 39 |
| Day ammonia Peaked | 10 | 6 | 18 | 10 |
| Peak ammonia value | 245 | 155 | 146 | 176 |
| Antimicrobial agents at time of diagnosis | AZ, DO | AZ, L | AZ, DO, L | AZ, L |
| CE/V/ME/L/MI | ME | CE/V/ | CE/V/ME/ME |
AA, african american; A Fib, Atrial fibrillation; AMS, altered mental status; AZ, azithromycin; B, basiliximab; BL, bilateral; CA, caucasian american; CE, cefepime; CMV, cytomegalovirus, D, donor, DO, doxycycline; DVT, deep vein thrombosis; EBV, epstein barr virus; ECMO, extracorporeal membrane oxygenation; F, female; H, hispanic; I, intermediate; IPF, idiopathic pulmonary fibrosis; L, levofloxacin; M, male; ME, metronidazole; MI, micafungin; MMF, mycophenolate mofetil; MP, methylprednisolone; MV, mechanical ventilation; MOF, multiorgan failure; PE, pulmonary emphysema; PH, pulmonary hypertension; PRESS, posterior reversible encephalopathy syndrome; RA ILD, rheumatoid arthritis interstitial lung disease; R, recipient; T, tacrolimus; V, vancomycin.
Ammonia level at the day of transplantation.