What does it mean if a liver transplant patient has a fever?

Updated: Dec 31, 2017
  • Author: Lemi Luu, MD, RDMS, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Fever is most commonly caused by infection but also may be due to rejection or drugs. Signs of infection are related to the type and location of infection.

Because of immunosuppression, liver transplant recipients do not often show classic signs and symptoms of infection. They have a wider variety of common and opportunistic infections, many of which are typically more challenging to diagnose and treat. [13] Symptoms associated with infection may be masked because of the immunosuppressant regimen; therefore, a high index of suspicion is required during evaluation of the patient.

Fever may be low-grade or absent, and leukocytosis may not be present. Pain at sites of infection may be minimal because of the patient's decreased ability to mount an inflammatory response. Infection may progress more rapidly than in the nonimmunocompromised patient and may be more difficult to eradicate. [14] Adrenal insufficiency must also be considered in these patients due to their chronic steroid use, and stress-dose steroids such as hydrocortisone may be needed. [3]

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