Sepsis and Organ Transplants

Organ transplants are increasingly common. In the United States alone, almost 40,000 people received life-saving transplants in 2020. The most commonly transplanted organs are kidneys, hearts, and livers. Other frequently transplanted organs include the lungs, pancreas, and intestines. As of late 2021, there were over 100,000 people registered with UNOS (United Network for Organ Sharing), the national transplant system, waiting for an organ.

Organ transplant surgeries are complex, major procedures. As with all surgeries, a potential complication is an infection. Infections are also a concern while people wait for organs. In addition, transplant recipients must take anti-rejection medications for the rest of their life. These medications affect their immune system, which also increases their risk of infection. Any time someone develops an infection, they could develop sepsis.

Sepsis is a life-threatening emergency that happens when your body’s response to an infection damages vital organs and, often, causes death. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Suggested Citation:
Sepsis Alliance. Sepsis and Organ Transplants. 2024. https://www.sepsis.org/sepsisand/organ-transplants/

Updated March 14, 2024.

 

More About Organ Transplants

Causes

There are many reasons why someone may need an organ transplant. Here are a few examples for the liver, kidney, and heart:

Liver: The liver is an essential organ. The organ has several functions, including helping the body eliminate waste and toxins. Liver failure can be sudden and there is no treatment that can help, like dialysis can for kidney failure. Liver failure could be due to trauma, medication overdoses, some herbal supplements, toxins, and sepsis. Damage can also occur slowly due to chronic diseases, like hepatitis or other conditions.

Kidney: Humans can live with one kidney, but the only cure is a transplant if neither kidney is functioning properly. Dialysis can prolong life, but this is not a cure and dialysis has risks of its own, including infections. Kidneys help filter waste from the body, maintain a balance of fluid in the body, and regulate blood pressure, among other roles.

Like liver failure, kidney damage can be acute (sudden) or chronic. The most common cause of acute kidney injury is a severe drop in blood pressure, as in shock or serious blood loss. It can also be caused by overuse or overdose of some medications like nonsteroidal anti-inflammatory drugs (NSAIDs), as well as severe allergic reactions and major injuries, among others.

Heart: Someone in severe heart failure would need a heart transplant. Heart failure can be caused by damage to the heart due to a heart attack, chronic heart disease, heart defects, drug abuse, chronic lung disease, infections, and more.

People waiting for a heart transplant may need an artificial heart while waiting, but this is not a long-term solution, nor is everyone a candidate for mechanical devices.

Sepsis Risks

There are many reasons why someone who needs or gets an organ transplant is at risk for infection. This means they are at risk for sepsis.

Before the transplant:

The most common risk for people with kidney disease is dialysis. Read more about sepsis and dialysis here.

Those with liver diseases are immunocompromised, which means their immune system isn’t working well enough to prevent infection. A study from the Netherlands found that 44% of patients on the liver transplant waiting list developed an infection, and almost a quarter had to be taken off the list, or they died before they could be removed.

People waiting for a lung transplant are usually susceptible to respiratory viruses, even a cold or flu.

The infection risk remains for most patients waiting for any organ.

After the transplant:

After the transplant may be the most serious time for infection and sepsis risk. There is always a chance of infection from the surgery itself. There is also a risk of healthcare-acquired infections, which increases with patients’ length of time in the hospital or a rehabilitation or convalescent setting.

People who have had organ transplants often go on to live healthy and fulfilling lives, but they must always remain vigilant about their health. The anti-rejection medications they must take to keep their body from rejecting the transplanted organ also lowers the body’s ability to fight infections. Because of this, transplant recipients must watch for signs of infection regardless of the type of transplant they received.

The signs and symptoms of an infection would depend on the type of infection present. For example, a urinary tract infection (UTI) could cause burning on urination, foul-smelling urine, and the need to urinate frequently; pneumonia could cause fever, cough, and weakness; and an infected skin wound could cause redness and warmth around the wound, discharge from the wound, increased pain and fever. If you have had a transplant and suspect you have an infection, contact your doctor or transplant care team right away.

Transplants Caused by Sepsis

Sometimes, it is severe sepsis or septic shock that causes organ damage. In most cases, the damage is temporary and sepsis survivors regain most if not all of the organ’s use. But sometimes, the damage is too severe, and the only chance for survival is a transplant.

One example of a sepsis survivor who falls in this category is singer Angelica Hale. At four years old, Angelica developed pneumonia, which triggered sepsis. This, in turn, caused kidney failure, and she needed a transplant.

Regardless of the risk factors, anyone on a transplant list or who has had a transplant needs to be vigilant about infection prevention. They should discuss who to contact with their doctor or transplant team if they suspect they may have an infection.

Related Resources

Information Guide

Surgery

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Liver Disease

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Stephanie A.

My daughter Stephanie has 5 life-threatening conditions (including transplant) and autism just to keep it interesting. (Sepsis and Organ Transplants) She has had 3 hospitalizations due to sepsis, most recently this year Thanksgiving weekend. The first time I think she just relapsed and 3 days later we were back in the ER and the local hospital sent her to the transplant clinic. This time we told them that the Zosyn they had her on last time didn’t work, and the transplant clinic put her on Meropenum. The last time we mentioned this and they immediately put her on Meropenum and ... Read Full Story

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Donna Swain

Unfortunately, I am all too familiar with sepsis. I am very prone to UTIs, but it is rare that I recognize that I have one because I get no symptoms, until it’s too late! (Sepsis and Urinary Tract Infections) Without the usual symptoms of a UTI, the infection gets out of control and I quickly becomes septic. I must be very careful with this because in 2015, I had a liver transplant (unrelated to my UTIs or sepsis). (Sepsis and Organ Transplants, Sepsis and Impaired Immune System) Unfortunately, when I become septic, I get very confused, disoriented, and unable to ... Read Full Story

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Organ Transplants