0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

TREATMENT

■ Methylprednisolone, 1 g IV
■ Isoproterenol for bradydysrhythmias
■ Dopamine or dobutamine for hypotension

Liver Transplant

SYMPTOMS/EXAM

■ Fever
■ Anorexia
■ Abdominal pain, ascites
■ Decreased bile output or change in color
■ Abnormal liver function tests

DIFFERENTIAL

■ Vascular thrombosis, biliary anastomotic leak/obstruction, infection, drug
toxicity

DIAGNOSIS

■ CBC, chemistries, coagulation panel, cultures, hepatic ultrasound

TREATMENT

■ Methylprednisolone, 500 mg 1 g IV
■ Broad spectrum antibiotics if biliary leak is present

INFECTION IN TRANSPLANT RECIPIENTS

Infection is the primary cause of death after transplantation and must be
considered in all transplant recipients who appear to be suffering from re-
jection. Transplant recipients are at risk of infections transmitted from
donor to recipient at the time of transplantation, or reactivation of latent
infections that become symptomatic following the initiation of immuno-
suppressive treatment.

Infections in the First Month

■ Bacteria—most often related to the surgery itself (eg, IV lines, intubation,
nosocomial pathogens).
■ Candida
■ HSV

Infections From First to Sixth Month

■ Viruses
■ CMV: Presents with pneumonitis, gastrointestinal, renal, skin, or CNS
infection and can trigger or exacerbate organ rejection; treat with IV
ganciclovir
■ EBV—clinical effects similar to CMV, also causes a mononucleosis-
like syndrome.
■ Hepatitis

Atropine does not increase

HRin patients with a heart

transplant. Use isoproterenol,

dopamine, or dobutamine.

Transplanted hearts are

denervated. Myocardial

ischemia will not present with

angina but will present as heart

failure or with sudden death.

Symptomatic infection with

CMVbegins a median of 40

days after transplantation.