History and Examination
History
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
Examination
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