Transplant Recipient With Fever, A Practical Approach

The main etiologies of fever in a post- transplant patient are infection (the most common cause), allograft rejection, drug hypersensitivity and malignancy. In respect of infectious diseases, the post- transplant period is divided into first month (mostly pyelonephritis [by the usual organisms facialiated by immunosuppression and increased rate of reflux, which usually leads to renal failure] and pneumonia), second to sixth months (CMV is the most important organism, others include: listeria(most common cause of bacterial CNS infection in these people), nocardia, salmonella, mycobacteria and pneumocystis carinii) and after the sixth month (which kidney function determines whether the infection is like the general population pattern or not. For the later, chronic viral infections (e. g., EBV, CMV and HIV) are the most common. pneumocystis carinii is less likely after the sixth month.) Rejection should be considered in patients with fever and organ dysfunction. Drug fever may be associated with beta-lactam antibiotics, sulfonamides, amphothericin B, a number of immunosuppressive agents (e.g., OKT3 and azathioprin). Most agents produce fever following 7-10 days of administration. The most common malignancies seen in these patients are skin tumors and lymphoproliferative disorders.