Sepsis in Solid-Organ Transplant Patients

• Published in: Shock (Augusta, Ga.) Vol. 47; no. 1S Suppl 1; pp. 12 - 16
• Main Authors: Bafi, Antônio Tonete, Tomotani, Daniere Yurie Vieira, de Freitas, Flávio Geraldo Rezende
• Format: Journal Article
• Language: English
• Published: United States by the Shock Society 01-01-2017
• Subjects: Female; Humans; Immunosuppressive Agents - therapeutic use; Male; Organ Transplantation - statistics & numerical data; Sepsis - drug therapy; Sepsis - etiology; Shock, Septic - drug therapy; Shock, Septic - etiology
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/SHK.0000000000000700

ABSTRACTThe growing population of solid organ transplant (SOT) recipients is at a significantly increased risk for developing infections. In some patients, the infection can lead to a dysregulated systemic inflammatory response with acute organ dysfunction. SOT recipients with sepsis tend to have less fever and leukocytosis instances. Moreover, they have diminished symptoms and attenuated clinical and radiologic findings. The current management of sepsis is similar to general patients. It relies mainly on early recognition and treatment, including appropriate administration of antibiotics and resuscitation with intravenous fluids and vasoactive drugs when needed. The infusion of fluids should be closely monitored because elevated central venous pressure levels and fluid overload can be particularly harmful. There is no consensus on how to manage immunosuppressive therapies during sepsis, although dose reduction or withdrawal is suggested to improve the host immunological response. There is compelling evidence suggesting that infections are associated with reduced allograft and patient survival. However, the traditional belief that SOT patients who develop sepsis have worse outcomes than non-transplanted patients has been challenged.