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An alternative to dialysis for ESRD patients is renal transplantation. A successful transplant can allow a dialysis‐dependent patient to live a nearly normal.

Typically, the patient’s new kidney is implanted in the abdominal cavity or pelvis. This has implications for any patient complaining of abdominal pain. A renal cause (e.g., transplant rejection) must be considered. Furthermore, the kidney is not protected in its native location in the retroperitoneum. The physical exam and focused history after trauma should be mindful of this anatomical difference, although outcomes and injury patterns may not be significantly different from those of nontransplant patients [10].

Kidney transplant patients continue to receive immunosuppressive medication to avoid rejection. They may not mount fevers with infection and are at risk for atypical and opportunistic infections. Vague and mild symptoms may actually be concerning signs and should warrant careful evaluation. A thorough medication history can alert the EMS clinician to the presence of immunosuppression.