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.
Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection. Sepsis and septic shock can result from an infection anywhere in the body. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain, fatigue, organ dysfunction, and/or amputations.
It can also happen that sepsis causes the need for a transplant. Severe sepsis causes organ dysfunction. If the organ doesn’t recover and become functional, the survivor may need a transplant.
Why do a transplant?
There are many reasons why an organ may need to be replaced. Here are a few examples for the liver, kidney, and heart:
Liver: The liver is an essential organ. No treatments can help prolong life if the liver doesn’t work properly. The organ has several functions, including helping the body eliminate waste and toxins. Liver failure can be sudden. This 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.
Transplant-related sepsis risk
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 decreases 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.
When sepsis causes the need for a transplant
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.
If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”
You can learn more about infection prevention among people who are immunocompromised by clicking here.
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Suggested Citation: Sepsis Alliance. Sepsis and Organ Transplants. 2022. https://www.sepsis.org/sepsisand/organ-transplants/
Updated February 10, 2022.