Impact of solid organ transplantation and immunosuppression on fever, leukocytosis, and physiologic response during bacterial and fungal infections

• Published in: Clinical transplantation Vol. 13; no. 3; pp. 260 - 265
• Main Authors: Sawyer, Robert G, Crabtree, Traves D, Gleason, Thomas G, Antevil, Jared L, Pruett, Timothy L
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard 01-06-1999; Blackwell
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Bacterial Infections - epidemiology; Bacterial Infections - immunology; Biological and medical sciences; Chi-Square Distribution; Clinical death. Palliative care. Organ gift and preservation; fever; Fever - epidemiology; Fever - immunology; Humans; Immunosuppressive Agents - therapeutic use; infection; Leukocytosis - epidemiology; Leukocytosis - immunology; Medical sciences; Mycoses - epidemiology; Mycoses - immunology; Opportunistic Infections - epidemiology; Opportunistic Infections - immunology; Organ Transplantation; Prospective Studies; response; solid organ transplantation; Human; Immunopathology; Immune response; Mycosis; Pathophysiology; Transplantation; Homotransplantation; Fever; Infection; Immunosuppression; Leukocytosis; Surgery; Bacteriosis; Organ
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1034/j.1399-0012.1999.130307.x

Immunosuppressed solid organ transplant patients may exhibit a blunted response to infection compared to non‐transplant patients. To test this hypothesis, we prospectively identified all episodes of bacterial and fungal infection on the in‐patient abdominal organ transplant service in our hospital, in 1997, and compared them to infected general surgery and trauma admissions treated simultaneously on the same wards. Eighty‐two infections occurred in transplant patients versus 463 in non‐transplant patients. Transplant patients demonstrated an overall greater physiologic response [Acute Physiology and Chronic Health Evaluation (APACHE II) and Acute Physiology Scores (APS) at the time of infection of 17.0±0.7 and 10.3±0.6, respectively, vs. 12.2±0.4 and 8.0±0.3 for non‐transplant patients, p≦0.003], with a similar maximum temperature (38.0±0.1 vs. 38.2±0.1°C, p=0.2) and white blood cell (WBC) count (12.1±1.0 vs. 13.9±0.4 k/mL, p=0.08). Upon further analysis of subgroups, patients receiving mycophenolate or azathioprine had significantly lower maximum temperatures (37.9±0.2°C) and WBC counts (11.0±0.9 k/mL) when compared to non‐transplant patients, while steroids appeared to have little effect on the systemic inflammatory response. Overall mortality was similar between groups. In general, solid organ transplant recipients exhibit a physiologic response to bacterial or fungal infection (as measured by the APS) at least as great as that seen in non‐transplant surgical patients, although mycophenolate and azathioprine appear to slightly depress the ability to respond with fever and leukocytosis. None of these differences appeared to affect overall mortality.