Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sepsis in a transplant recipient
Shock, hypoxaemia, encephalopathy, graft dysfunction, rapidly progressive infiltrates or severe abdominal findings can reflect bacterial sepsis, an anastomotic complication or disseminated opportunistic infection.
Action: Resuscitate with the transplanted organ in mind, take blood and focus cultures without delaying active empirical therapy, contact the transplant centre and microbiology immediately, and obtain urgent source-control or critical-care support. Do not independently stop all immunosuppression.
Synopsis
Use transplant timing and net immunosuppression to recognise ordinary and opportunistic infection, protect graft function, obtain decisive samples and coordinate antimicrobial and immunosuppressive treatment.
In the first month, prioritise donor-derived, surgical, device-associated and healthcare-acquired infection, including wound, anastomotic, urinary, pulmonary, bloodstream and intra-abdominal sources.
From roughly one to six months, viral reactivation and opportunists become prominent: CMV, EBV, BK polyomavirus, Pneumocystis, Aspergillus, Candida, nocardia, toxoplasma and tuberculosis depend on organ, serostatus and prophylaxis.
After six months, stable recipients mainly acquire community infections, while chronic graft dysfunction or intensified immunosuppression sustains late opportunistic risk.
Key red flags
Hypotension, rising lactate, confusion, oliguria or increasing oxygen need requires immediate sepsis treatment even when fever and CRP are modest.
Early postoperative source
Wound change, line symptoms, urinary obstruction, bile leak, anastomotic pain, collection or ventilator-associated disease within the first month points toward surgical and healthcare pathogens.
Investigation priorities
01
First-line sepsis and graft panelFirst stepFirst line
Define severity, recover bacteria and detect organ or graft dysfunction before therapy reduces diagnostic yield.
Management branches
UNSTABLEResuscitate and cover likely sources
A transplant recipient has shock, organ dysfunction, hypoxaemia or another severe infection phenotype.
Perform ABCDE, obtain cultures and urgent laboratory tests, then start the locally approved source-based intravenous regimen without waiting for transfer or specialist arrival.
Use prior susceptibility, current prophylaxis, organ type, time after transplant and healthcare exposure to identify resistant Gram-negative, enterococcal, staphylococcal and fungal gaps.
TIMELINEMatch pathogens to immune phase
The patient is stable enough for a structured diagnostic search after immediate threats are addressed.
Key medicines
Empirical antibacterial therapyGive the hospital's transplant- and source-specific intravenous sepsis regimen at full loading doses, then adjust for renal or hepatic function and extracorporeal support after cultures are obtained when safe.
ValganciclovirFor CMV infection or disease, give 900 mg orally twice daily in an adult with normal renal function for at least 2 weeks, then continue to specialist clinical and virological stopping criteria.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.