Subscribe to RSS
DOI: 10.1055/s-0041-1735150
Survival Outcome of Sepsis in Recipients of Solid Organ Transplant
![](https://www.thieme-connect.de/media/srccm/202105/lookinside/thumbnails/10-1055-s-0041-1735150_210512-1.jpg)
Abstract
Sepsis is a complex disease stemming from a dysregulated immune response toward an infectious agent. In transplantation, sepsis remains one of the leading causes of morbidity and mortality. Solid organ transplant recipients have impaired adaptive immunity due to immunosuppression required to prevent rejection. Immunosuppression has unintended consequences, such as increasing the risk of infections and sepsis. Due to its high morbidity and mortality, early detection of sepsis is paramount to start aggressive treatment. Several biomarkers or combination of biomarkers of sepsis have emerged in the last decade, but they are not dependable for early diagnosis or for outcome prognosis.
Publication History
Article published online:
20 September 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Hamandi B, Law N, Alghamdi A, Husain S, Papadimitropoulos EA. Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada - a retrospective cohort study. Transpl Int 2019; 32 (10) 1095-1105
- 2 Kalil AC, Opal SM. Sepsis in the severely immunocompromised patient. Curr Infect Dis Rep 2015; 17 (06) 487
- 3 Gotur DB, Masud FN, Ezeana CF. et al. Sepsis outcomes in solid organ transplant recipients. Transpl Infect Dis 2020; 22 (01) e13214
- 4 Rhodes A, Evans LE, Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43 (03) 304-377
- 5 Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018; 44 (06) 925-928
- 6 Wang Y, Gu Y, Huang F. et al. Risk factors for sepsis based on sepsis-3 criteria after orthotopic liver transplantation. Mediators Inflamm 2018; 2018: 8703172
- 7 Guenette A, Husain S. Infectious complications following solid organ transplantation. Crit Care Clin 2019; 35 (01) 151-168
- 8 Trzeciak S, Sharer R, Piper D. et al. Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 2004; 22 (07) 530-533
- 9 Kalil AC, Syed A, Rupp ME. et al. Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study. Clin Infect Dis 2015; 60 (02) 216-222
- 10 Donnelly JP, Locke JE, MacLennan PA. et al. Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis. Clin Infect Dis 2016; 63 (02) 186-194
- 11 de Carvalho MA, Freitas FG, Silva Junior HT, Bafi AT, Machado FR, Pestana JO. Mortality predictors in renal transplant recipients with severe sepsis and septic shock. PLoS One 2014; 9 (11) e111610
- 12 Sawyer RG, Crabtree TD, Gleason TG, Antevil JL, Pruett TL. Impact of solid organ transplantation and immunosuppression on fever, leukocytosis, and physiologic response during bacterial and fungal infections. Clin Transplant 1999; 13 (03) 260-265
- 13 Pelletier SJ, Crabtree TD, Gleason TG. et al. Characteristics of infectious complications associated with mortality after solid organ transplantation. Clin Transplant 2000; 14 (4, pt 2): 401-408
- 14 Bafi AT, Tomotani DY, de Freitas FG. Sepsis in solid-organ transplant patients. Shock 2017; b (1S): (Suppl. 01) 12-16
- 15 Bige N, Zafrani L, Lambert J. et al. Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis 2014; 16 (04) 588-596
- 16 Chou NK, Ko WJ, Chi NH. et al. Sparing immunosuppression in heart transplant recipients with severe sepsis. Transplant Proc 2006; 38 (07) 2145-2146
- 17 Sun Q, Liu ZH, Chen J. et al. An aggressive systematic strategy for acute respiratory distress syndrome caused by severe pneumonia after renal transplantation. Transpl Int 2006; 19 (02) 110-116
- 18 Bodro M, Sabé N, Tubau F. et al. Extensively drug-resistant Pseudomonas aeruginosa bacteremia in solid organ transplant recipients. Transplantation 2015; 99 (03) 616-622
- 19 Wan Q, Luo A, Ye Q, Liu S, Zhou J. Predictors of shock and mortality in solid organ transplant recipients with bacteremia caused by non-lactose-fermenting gram-negative bacilli. Infect Dis (Lond) 2016; 48 (01) 32-39
- 20 Kalil AC, Dakroub H, Freifeld AG. Sepsis and solid organ transplantation. Curr Drug Targets 2007; 8 (04) 533-541
- 21 McCreery RJ, Florescu DF, Kalil AC. Sepsis in immunocompromised patients without human immunodeficiency virus. J Infect Dis 2020; 222 (Suppl. 02) S156-S165
- 22 Kalil AC, Sandkovsky U, Florescu DF. Severe infections in critically ill solid organ transplant recipients. Clin Microbiol Infect 2018; 24 (12) 1257-1263
- 23 Wagener MM, Yu VL. Bacteremia in transplant recipients: a prospective study of demographics, etiologic agents, risk factors, and outcomes. Am J Infect Control 1992; 20 (05) 239-247
- 24 Weinstein MP, Towns ML, Quartey SM. et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24 (04) 584-602
- 25 Oriol I, Sabé N, Melilli E. et al. Factors influencing mortality in solid organ transplant recipients with bloodstream infection. Clin Microbiol Infect 2015; 21 (12) 1104.e9-1104.e14
- 26 Camargo LF, Marra AR, Pignatari AC. et al; Brazilian SCOPE Study Group. Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population. Transpl Infect Dis 2015; 17 (02) 308-313
- 27 Montano-Loza AJ. Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation. Curr Opin Clin Nutr Metab Care 2014; 17 (03) 219-225
- 28 Neviere R, Trinh-Duc P, Hulo S. et al. Predictive value of exhaled nitric oxide and aerobic capacity for sepsis complications after liver transplantation. Transpl Int 2016; 29 (12) 1307-1316
- 29 Toshima T, Shirabe K, Kurihara T. et al. Profile of plasma amino acids values as a predictor of sepsis in patients following living donor liver transplantation: Special reference to sarcopenia and postoperative early nutrition. Hepatol Res 2015; 45 (12) 1170-1177
- 30 Candel FJ, Grima E, Matesanz M. et al. Bacteremia and septic shock after solid-organ transplantation. Transplant Proc 2005; 37 (09) 4097-4099
- 31 Nemes B, Sárváry E, Sótonyi P. et al. Factors in association with sepsis after liver transplantation: the Hungarian experience. Transplant Proc 2005; 37 (05) 2227-2228
- 32 Yoshizumi T, Shirabe K, Ikegami T. et al. Decreased immunoglobulin G levels after living-donor liver transplantation is a risk factor for bacterial infection and sepsis. Transpl Infect Dis 2014; 16 (02) 225-231
- 33 Sugimoto T, Sakaguchi M, Ogawa N. et al. Marked hypercalcaemia in sepsis-induced multiple organ failure. Nephrol Dial Transplant 2007; 22 (04) 1272-1273
- 34 Kinnunen S, Karhapää P, Juutilainen A, Finne P, Helanterä I. Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol 2018; 13 (05) 755-762
- 35 Nakamura M, Seki G, Iwadoh K. et al. Acute kidney injury as defined by the RIFLE criteria is a risk factor for kidney transplant graft failure. Clin Transplant 2012; 26 (04) 520-528
- 36 Moreno A, Cervera C, Gavaldá J. et al. Bloodstream infections among transplant recipients: results of a nationwide surveillance in Spain. Am J Transplant 2007; 7 (11) 2579-2586
- 37 Kao KC, Chiu LC, Hung CY. et al. Coinfection and mortality in pneumonia-related acute respiratory distress syndrome patients with bronchoalveolar lavage: a prospective observational study. Shock 2017; 47 (05) 615-620
- 38 Haak BW, Prescott HC, Wiersinga WJ. Therapeutic potential of the gut microbiota in the prevention and treatment of sepsis. Front Immunol 2018; 9: 2042
- 39 Lee J, Banerjee D. Metabolomics and the microbiome as biomarkers in sepsis. Crit Care Clin 2020; 36 (01) 105-113
- 40 Dickson RP. The microbiome and critical illness. Lancet Respir Med 2016; 4 (01) 59-72
- 41 Sharma NK, Salomao R. Sepsis through the eyes of proteomics: the progress in the last decade. Shock 2017; 47 (1S): (Suppl. 01) 17-25
- 42 Stringer KA, Serkova NJ, Karnovsky A, Guire K, Paine III R, Standiford TJ. Metabolic consequences of sepsis-induced acute lung injury revealed by plasma 1H-nuclear magnetic resonance quantitative metabolomics and computational analysis. Am J Physiol Lung Cell Mol Physiol 2011; 300 (01) L4-L11
- 43 Schmerler D, Neugebauer S, Ludewig K, Bremer-Streck S, Brunkhorst FM, Kiehntopf M. Targeted metabolomics for discrimination of systemic inflammatory disorders in critically ill patients. J Lipid Res 2012; 53 (07) 1369-1375
- 44 Ferrario M, Cambiaghi A, Brunelli L. et al. Mortality prediction in patients with severe septic shock: a pilot study using a target metabolomics approach. Sci Rep 2016; 6: 20391
- 45 Qian WJ, Jacobs JM, Camp II DG. et al. Comparative proteome analyses of human plasma following in vivo lipopolysaccharide administration using multidimensional separations coupled with tandem mass spectrometry. Proteomics 2005; 5 (02) 572-584
- 46 DeCoux A, Tian Y, DeLeon-Pennell KY. et al. Plasma glycoproteomics reveals sepsis outcomes linked to distinct proteins in common pathways. Crit Care Med 2015; 43 (10) 2049-2058
- 47 Malmström E, Davidova A, Mörgelin M. et al. Targeted mass spectrometry analysis of neutrophil-derived proteins released during sepsis progression. Thromb Haemost 2014; 112 (06) 1230-1243
- 48 Liu J, Li J, Deng X. Proteomic analysis of differential protein expression in platelets of septic patients. Mol Biol Rep 2014; 41 (05) 3179-3185
- 49 Shen Z, Want EJ, Chen W. et al. Sepsis plasma protein profiling with immunodepletion, three-dimensional liquid chromatography tandem mass spectrometry, and spectrum counting. J Proteome Res 2006; 5 (11) 3154-3160
- 50 Andaluz-Ojeda D, Bobillo F, Iglesias V. et al. A combined score of pro- and anti-inflammatory interleukins improves mortality prediction in severe sepsis. Cytokine 2012; 57 (03) 332-336
- 51 Punyadeera C, Schneider EM, Schaffer D. et al. A biomarker panel to discriminate between systemic inflammatory response syndrome and sepsis and sepsis severity. J Emerg Trauma Shock 2010; 3 (01) 26-35
- 52 Ludwig KR, Hummon AB. Mass spectrometry for the discovery of biomarkers of sepsis. Mol Biosyst 2017; 13 (04) 648-664
- 53 Sandkovsky U, Kalil AC, Florescu DF. The use and value of procalcitonin in solid organ transplantation. Clin Transplant 2015; 29 (08) 689-696
- 54 Memar MY, Baghi HB. Presepsin: a promising biomarker for the detection of bacterial infections. Biomed Pharmacother 2019; 111: 649-656
- 55 Wu J, Hu L, Zhang G, Wu F, He T. Accuracy of presepsin in sepsis diagnosis: a systematic review and meta-analysis. PLoS One 2015; 10 (07) e0133057
- 56 Tziolos N, Kotanidou A, Orfanos SE. Biomarkers in infection and sepsis: can they really indicate final outcome?. Int J Antimicrob Agents 2015; 46 (Suppl. 01) S29-S32
- 57 Dolin HH, Papadimos TJ, Stepkowski S, Chen X, Pan ZK. A novel combination of biomarkers to herald the onset of sepsis prior to the manifestation of symptoms. Shock 2018; 49 (04) 364-370
- 58 Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13 (05) 426-435
- 59 Yang Y, Xie J, Guo F. et al. Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients. Ann Intensive Care 2016; 6 (01) 51
- 60 Han JH, Nachamkin I, Coffin SE. et al; Prevention Epicenters Program of the Centers for Disease Control and Prevention. Use of a combination biomarker algorithm to identify medical intensive care unit patients with suspected sepsis at very low likelihood of bacterial infection. Antimicrob Agents Chemother 2015; 59 (10) 6494-6500
- 61 Shapiro NI, Trzeciak S, Hollander JE. et al. A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med 2009; 37 (01) 96-104
- 62 Mearelli F, Fiotti N, Giansante C. et al. Derivation and validation of a biomarker-based clinical algorithm to rule out sepsis from noninfectious systemic inflammatory response syndrome at emergency department admission: a multicenter prospective study. Crit Care Med 2018; 46 (09) 1421-1429
- 63 Schinkel M, Paranjape K, Nannan Panday RS, Skyttberg N, Nanayakkara PWB. Clinical applications of artificial intelligence in sepsis: A narrative review. Comput Biol Med 2019; 115: 103488
- 64 Rhee C, Dantes R, Epstein L. et al; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA 2017; 318 (13) 1241-1249