Unique Considerations in the Management of Early Sepsis in Orthotopic Heart Transplant Recipients: A Case Study

Orthotopic heart transplant (OHT) recipients are immune-compromised patients and are at a significantly increased risk for developing infections. Sepsis is life-threatening, and without early detection and treatment it can lead to a dysregulated systemic inflammatory response with acute organ dysfunction. However, the clinical profile of OHT recipients with sepsis is different as these patients tend to have less fever and leukocytosis. Their presentation may not provoke clinical suspicion of sepsis as they may have diminished symp-toms and attenuated clinical and radiologic findings. The management of sepsis in these patients are similar to non-transplanted patients. It relies main-ly on early recognition and treatment, including appropriate administration of antibiotics, resus-citation with intravenous fluids, and vasoactive drugs. The infusion of fluid however needs to be closely monitored because elevated filling pressures including central venous pressure levels can reflect fluid overload, right ventricular dysfunction and be a precursor to cardiogenic shock.