What are the goals of care when liver transplant patients present with signs of infection?

Updated: Dec 31, 2017
  • Author: Lemi Luu, MD, RDMS, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The clinician must remember that most liver transplant patients are very immunosuppressed and typically come to medical attention as a last resort. Every complaint should be taken seriously, and the transplant team should at least know of every emergency department (ED) visit made by the transplant patient. Patients who may be infected require admission because they will need a decrease in their immunosuppressants and are at risk for rejection. [15, 16]

A major goal of care is to evaluate for evidence of infection or rejection in patients who present with compatible symptoms. Fever of unknown origin or suspicion of rejection should lead to consideration for admission for further evaluation. If bacterial infection is suspected, obtain cultures and initiate antibiotics based on likely bacterial pathogens, as in the nonimmunocompromised patient. Broad-spectrum antibiotics are used if the source is unknown.

Because these patients are on long-term corticosteroids, stress of infection or other intercurrent illness should lead to consideration of early stress-dose steroid administration and intravenous antibiotics in consultation with the transplant medicine service. Be aware that a large number of commonly prescribed drugs can affect the blood levels of immunosuppressants and should be prescribed only after reviewing prescribing information for drug interactions.

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