History and Examination


Important features of history:

  • Date of transplant
  • Time course of symptoms
  • Any known episodes of rejection
  • Details of anti-rejection drugs and patient’s compliance
  • Any history to suggest sepsis: General features such as fever, or symptoms of a specific focus such as cough/ expectoration
  • Cardiac symptoms (which might suggest graft failure due to rejection or vasculopathy): Breathlessness/paroxysmal nocturnal dyspnea (PND)/orthopnoea; dizziness or syncope; palpitations


Important clinical signs:

  • Tachycardia – may be normal post transplant
  • Bradycardia – common soon after surgery
  • Blood pressure – often high in transplant patients. May be low in sepsis or graft failure
  • Lung fields – crepitations in heart failure or pneumonia
  • Ankle oedema in right heart failure
  • Temperature – elevated in sepsis, but this is not a reliable marker for infection