Fever in renal transplant recipients
Use time since transplant and prophylaxis to predict the infection, remember non-infective causes, and watch tacrolimus interactions.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Fever in a kidney transplant recipient is an emergency until shown otherwise. Immunosuppression blunts fever and inflammation, so a low-grade temperature may mean serious infection.
- The likely cause depends on time since transplant, prophylaxis given, intensity of immunosuppression (recent rejection treatment, lymphocyte-depleting induction) and exposures (travel, region, food, pets).
- Not every fever is infection: think of rejection, drug fever, VTE and PTLD.
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Sources
- Kotton CN, Kumar D, Manuel O, Chou S et al. The Fourth International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation. Transplantation 2025;109(7):1066-110The Transplantation Society, 2025
- Kotton CN, Kamar N, Wojciechowski D et al. The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation. Transplantation 2024;108:1834-66The Transplantation Society, 2024
- AST Infectious Diseases Community of Practice guidelines, 4th edition. Clin Transplant 2019;33(9)American Society of Transplantation, 2019
- Australian Immunisation Handbook (Vaccination for people who are immunocompromised; Zoster)AU/NZAustralian Government Department of Health, Disability and Ageing
- Limaye AP et al. Letermovir vs valganciclovir for prophylaxis of cytomegalovirus in high-risk kidney transplant recipients: a randomized clinical trial. JAMA 2023;330:33-42JAMA, 2023
- Antibiotic (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Drug-drug interactions between letermovir and tacrolimus in Japanese renal transplant recipients simulated using a physiologically based pharmacokinetic modelPubMed (PMID 39444685), 2024
- Last updated
- 14 November 2026
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