INTRODUCTION

In the United States, solid organ transplants and hematopoietic stem cell transplants are increasingly common forms of treatment for a variety of medical conditions. The 1- and 5-year survival rates vary depending on the organ transplanted. In general, kidney, pancreas, and liver transplants have higher survival rates (86–98% at 1 year and 73–98% at 5 years) than do heart, lung, or combined heart-lung transplants. Overall, improvements in transplant candidate selection, surgical technique, immunosuppressive regimens, and long-term medical care have resulted in high survival rates from solid organ transplants. As the number of successful transplants increases, so does the number of acute care visits made by these patients. An understanding of the differential diagnosis of fever in a post-transplant patient, of the risk of infection at different times after transplant, and of the risk associated with various levels of immunosuppression can aid in a comprehensive and cost-effective work-up.

EPIDEMIOLOGY

Infectious complications are a serious cause of morbidity and mortality in post-transplant patients, with serious infection occurring in up to two-thirds of organ transplant patients. In one study of renal transplant recipients, the incidence of infection in the first year post-transplant ranged from 25% to 80%. In a separate study of liver transplant patients, up to 67% of recipients had one serious infection, and infection factored in 53% of early post-transplant deaths.