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Posttransplant Fever in Critically Ill Organ Transplant Recipients

  • Patricia Muñoz
  • Emilio Bouza
Chapter
  • 67 Downloads
Part of the Perspectives on Critical Care Infectious Diseases book series (CCID, volume 1)

Abstract

Fever is common in solid organ transplant (SOT) recipients (1). This chapter deals with the etiology, approach and outcome of clinical entities in which fever without an identifiable cause is the major finding. While, patients in the ward may also have severe infections, ICU stay poses unique risk factors for infection. We will therefore focus on fever in context of SOT recipients in the ICU. Our aim is to provide information and guidelines regarding most frequently encountered clinical scenarios relevant to critically ill febrile patients. Where no solid data were available, perspectives based on our own experience and opinion are presented.

Keywords

Transplant Recipient Orthotopic Liver Transplantation Invasive Aspergillosis Liver Transplant Recipient Febrile Episode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    O’Grady NP, Bane PS, Bartlett JG, et al. Practice guidelines for evaluating new fever in critically ill adult patients. Clin Infect Dis 1998;26:1042–59.PubMedCrossRefGoogle Scholar
  2. 2.
    Miller LW, Naftel DC, Bourge RC, et al. Infection after heart transplantation: a multiinstitutional study. Cardiac Transplant Research Database Group. J Heart Lung Transplant 1994;13(3):381–92.PubMedGoogle Scholar
  3. 3.
    Plöchl W, Pezawas L, Artemiou O, Grimm M, Klepetko W, Hiesmayr M. Nutritional status, ICU duration and ICU mortality in lung transplant recipients. Intensive Care Med 1996;22(11):1179–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Hsu J, Griffith BP, Dowling RD, et al. Infections in mortally ill cardiac transplant recipients. J Thorac Cardiovasc Surg 1989;98:506–9.PubMedGoogle Scholar
  5. 5.
    Cisneros Alonso C, Montero Castillo A, Moreno González E, Garcia Garcia I, Guillén Ramirez F, García Fuentes C. [Complications of liver transplant in intensive care. Experience in 130 cases] Rev Clin Esp 1991;189(6):264–7.Google Scholar
  6. 6.
    Plevak DJ, Southom PA, Narr BJ. Intensive-care unit experience in the Mayo liver transplantation program: the first 100 cases. Mayo Clin Proc 1989;64:433–445.PubMedCrossRefGoogle Scholar
  7. 7.
    Singh N, Gayowski T, Wagener MM. Intensive care unit management in liver transplant recipients: beneficial effect on survival and preservation of quality of life. Clin Transplant 1997;11(2):113–20.PubMedGoogle Scholar
  8. 8.
    Singh N, Chang FY, Gayowski T, Wagener M, Marino IR. Fever in liver transplant recipients in the intensive care unit. Clin Transplant 1999;13(6):504–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Sadaghdar H, Chelluri L, Bowles SA, Shapiro R. Outcome of renal transplant recipients in the ICU. Chest 1995;107(5):1402–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest 1998;113(5):1215–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Martinelli L, Rinaldi M, Pederzolli C, et al. Different results of cardiac transplantation in patients with ischemic and dilated cardiomyopathy. Eur J Cardiothorac Surg 1995;9(11):64450.CrossRefGoogle Scholar
  12. 12.
    Muñoz P, Muñoz RM, Palomo J, Rodriguez Creixéms M, Munoz R, Bouza E. Pneumocystis carinii infections in heart transplant patients. Twice a week prophylaxis. Medicine (Baltimore) 1997;76:415–422.CrossRefGoogle Scholar
  13. 13.
    Detre KM, Belle SH, Carr MA, et al. A report from the NIDDK Liver Transplantation Database. Clin Transpl 1989:129–41.Google Scholar
  14. 14.
    Wiebe K, Wahlers T, Harringer W, vd Hardt H, Fabel H, Haverich A. Lung transplantation for cystic fibrosis--a single center experience over 8 years. Eur J Cardiothorac Surg 1998;14(2):191–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Madden BP, Kamalvand K, Chan CM, Khaghani A, Hodson ME, Yacoub M. The medical management of patients with cystic fibrosis following heart-lung transplantation. Eur Respir J 1993;6(7):965–70.PubMedGoogle Scholar
  16. 16.
    Argenziano M, Catanese KA, Moazami N, et al. The influence of infection on survival and successful transplantation in patients with left ventricular assist devices. J Heart Lung Transplant 1997;16(8):822–31.PubMedGoogle Scholar
  17. 17.
    Fischer SA, Trenholme GM, Costanzo MR, Piccione W. Infectious complications in left ventricular assist device recipients. Clin Infect Dis 1997;24(1):18–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Masters RC, Hendry Pi, Davies RA, et al. Cardiac transplantation after mechanical circulatory support: a canadian perspective. Ann Thorac Surg 1996;61:1734–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Papanicolaou GA, Meyers BR, Meyers J, et al. Nosocomial infections with vancomycinresistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clin Infect Dis 1996;23(4):760–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Martín-Rabadán P, Muñoz P, Palomo J, Bouza E. Strongyloidiasis: The Harada-Mori test revisited. Clinical Microbiology and Infection 1999;5:374–376.PubMedCrossRefGoogle Scholar
  21. 21.
    Lafayette RA, Paré G, Schmid CH, King AJ, Rohrer RJ, Nasraway SA. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation. Clin Nephrol 1997;48(3):159–64.PubMedGoogle Scholar
  22. 22.
    Deschênes M, Belle SH, Krom RA, Zetterman RK, Lake JR. Early allograft dysfunction after liver transplantation: a definition and predictors of outcome. National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Transplantation 1998;66(3):302–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Reilly J, Mehta R, Teperman L, et al. Nutritional support after liver transplantation: a randomized prospective study [see comments]. JPEN J Parenter Enteral Nutr 1990;14(4):38691.CrossRefGoogle Scholar
  24. 24.
    Gurakar A, Hassanein T, Van Thiel DH. Right diaphragmatic paralysis following orthotopic liver transplantation. J Okla State Med Assoc 1995;88(4):149–53.PubMedGoogle Scholar
  25. 25.
    Paterson DL, Staplefeldt WH, Wagener MM, Gayowski T, Marino IR, Singh N. Intraoperative hypothermia is an independent risk factor for early cytomegalovirus infection in liver transplant recipients. Transplantation 1999;67(8):1151–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Maroto LC, Aguado JM, Carrascal Y, et al. Role of epicardial pacing wire cultures in the diagnosis of poststemotomy mediastinitis. Clin Infect Dis 1997;24(3):419–21.PubMedCrossRefGoogle Scholar
  27. 27.
    Paterson DL, Dominguez EA, Chang FY, Snydman DR, Singh N. Infective endocarditis in solid organ transplant recipients. Clin Infect Dis 1998;26(3):689–94.PubMedCrossRefGoogle Scholar
  28. 28.
    Mort TC, Yeston NS. The relationship of pre mortem diagnoses and post mortem findings in a surgical intensive care unit [see comments]. Crit Care Med 1999;27(2):299–303.PubMedCrossRefGoogle Scholar
  29. 29.
    Chang FY, Singh N, Gayowski T, Wagener MM, Marino IR. Fever in liver transplant recipients: changing spectrum of etiologic agents. Clin Infect Dis 1998;26(1):59–65.PubMedCrossRefGoogle Scholar
  30. 30.
    Muñoz P, Menasalvas A, Rodriguez-Créixems M, Desco. M, J.L. V, Bouza E. Postsurgical mediastinitis. A case control study. Clin Infect Dis 1997;25:1060–64.Google Scholar
  31. 31.
    Ostrowsky BE, Venkataraman L, EM DA, Gold HS, DeGirolami PC, Samore MH. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med 1999;159(13):1467–72.Google Scholar
  32. 32.
    Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis 1998;27(5):1266–77.PubMedCrossRefGoogle Scholar
  33. 33.
    Daas M, Plevak DJ, Wijdicks EF, et al. Acute liver failure: results of a 5-year clinical protocol. Liver Transpl Surg 1995;1(4):210–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Paterson DL, Singh N. Invasive aspergilloses in transplant recipients. Medicine 1999;78:123–38.PubMedCrossRefGoogle Scholar
  35. 35.
    Singh N, Gayowski T, Wagener MM, Marino IR. Pulmonary infiltrates in liver transplant recipients in the intensive care unit. Transplantation 1999;67(8):1138–44.PubMedCrossRefGoogle Scholar
  36. 36.
    Singh N, Gayowski T, Marino IR, Schlichtig R. Acute adrenal insufficiency in critically ill liver transplant recipients. Implications for diagnosis. Transplantation 1995;59(12):1744–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Hummel M, Warnecke H, Schüler S, Luding K, Hetzer R. [Risk of adrenal cortex insufficiency following heart transplantation]. Klin Wochenschr 1991;69(6):269–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Bromberg JS, Alfrey EJ, Barker CF, et al. Adrenal suppression and steroid supplementation in renal transplant recipients. Transplantation 1991;51(2):385–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Bromberg JS, Baliga P, Cofer JB, Rajagopalan PR, Friedman RJ. Stress steroids are not required for patients receiving a renal allograft and undergoing operation. J Am Coll Surg 1995;180(5):532–6.PubMedGoogle Scholar
  40. 40.
    Rodger RS, Watson MJ, Sellars L, Wilkinson R, Ward MK, Kerr DN. Hypothalamicpituitary-adrenocortical suppression and recovery in renal transplant patients returning to maintenance dialysis. Q J Med 1986;61(235):1039–46.PubMedGoogle Scholar
  41. 41.
    Sever MS, Turkmen A, Yildiz A, Ecder T, Orhan Y. Fever in dialysis patients with recently rejected renal allografts. Int J Artif Organs 1998;21(7):403–7.PubMedGoogle Scholar
  42. 42.
    Khan SU, Salloum J, PB OD, et al. Acute pulmonary edema after lung transplantation: the pulmonary reimplantation response. Chest 1999;116(1):187–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Singh N, Paterson DL, Gayowski T, Wagener MM, Marino IR. Predicting bacteremia and bacteremic mortality in liver transplant recipients. Liver transplantation 2000;6:54–61.PubMedGoogle Scholar
  44. 44.
    Jensen WA, Rose RM, Hammer SM, et al. Pulmonary complications of orthotopic liver transplantation. Transplantation 1986;42(6):484.PubMedCrossRefGoogle Scholar
  45. 45.
    Cisneros JM, Muñoz P, Torre-Cisneros J, et al. Pneumonia after heart transplantation: a multiinstitutional study. Clin Infect Dis 1998;27:324–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Muñoz P, Palomo J, Muñoz R, Rodriguez-Creixéms M, Pelaez T, Bouza E. Tuberculosis in heart transplant recipients. Clin Infect Dis 1995;21:398–402.PubMedCrossRefGoogle Scholar
  47. 47.
    Muñoz P, de la Torre J, Bouza E, et al. Invasive Aspergillosis In Transplant Recipients. A Large Multicentric Study. 36th ICAAC. American Society for Microbiology. 1996.Google Scholar
  48. 48.
    Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 1998;157(4 Pt 1):1159–64.PubMedCrossRefGoogle Scholar
  49. 49.
    Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG. Outcome of recipients of bone marrow transplants who require intensive-care unit support [see comments]. Mayo Clin Proc 1992;67(2):117–22.PubMedCrossRefGoogle Scholar
  50. 50.
    Paz HL, Crilley P, Weinar M, Brodsky I. Outcome of patients requiring medical ICU admission following bone marrow transplantation. Chest 1993;104(2):527–31.PubMedCrossRefGoogle Scholar
  51. 51.
    Hosenpud JD, Bennett LE, Keck BM, Fiol B, Boucek MM, Novick RJ. The registry of the international society for heart and lung transplantation: fifteenth official report-1998. J Heart Lung Transpl 1998;17:656–668.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Patricia Muñoz
    • 1
  • Emilio Bouza
    • 1
  1. 1.Servicio de Microbiología Clínica y Enfermedades InfecciosasHospital General Universitario “Gregorio MarañnMadridSpain

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