The Transplant Patient

Blood, Clots & Transfusion · ICU Decoded chapter 49 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to AST/ISHLT guidance.

Key points

Transplant sepsis follows a timeline: <1 mo nosocomial/donor, 1–6 mo opportunistic (CMV, PCP, fungi), >6 mo community.
Biopsy separates rejection from infection; treat confirmed rejection with pulse steroids per the organ protocol.
Maintain immunosuppression during critical illness (stress-dose steroids; hold calcineurin only per team, nephrotoxic).
CMV gets ganciclovir 5 mg/kg q12h (renal-adjusted); PCP prophylaxis is TMP-SMX.
CMV prophylaxis runs 3–6 months post-transplant in high-risk recipients.

Investigations

First tests: Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry.

Only if indicated: Blood cultures, Host- and syndrome-directed pathogen tests, Immunosuppressant trough level, Graft imaging / biopsy.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.

Locked

Treatment orders with doses
Why and when to send each test

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