Previous studies have shown that approximately 20% of febrile episodes in transplant recipients are not associated with infection. At our center, fever of unknown origin (FUO) is a common cause for readmission following pancreas-alone (PA) and simultaneous pancreas-kidney (SPK) transplant. This study aimed to characterize the incidence and outcomes of pancreas recipients with FUO during the first post-transplant year. All PA and SPK recipients with functioning grafts transplanted from 01/2011 to 08/2015 were included. Diagnosis of FUO was based upon previously accepted criteria adapted from Durack et al.¹ A total of 102 patients were reviewed and 92 included. Patients were on average 42 years old, and consisted of 51 (55%) male and 81 (88%) SPK recipients. Twenty-three (25%) patients experienced FUO resulting in 34 admissions, with median time to first FUO admission of 28 days post-transplant. Eight patients had multiple re-admissions for FUO. FUO accounted for 173 admission days with a median length of stay of 6 days. Evaluation of FUO consisted of blood/urine cultures (100%), CMV PCR (100%), chest x-ray (100%), non-head CT (78%), head CT (4%), MRI (9%), indium scan (22%) and lumbar puncture (4%). After ruling out infectious etiology, 17 patients were managed empirically with intravenous (IV) methylprednisolone (median dose 750 mg). Empiric treatment with IV methylprednisolone led to resolution of fever, but did not affect subsequent FUO readmission rates. Rates of documented infection and rejection at 1 year were similar in FUO and FUO-free patients (Table 1). In conclusion, FUO was common in pancreas transplants and was associated with frequent admissions, prolonged hospitalizations, and extensive diagnostic testing, though did not seem to be associated with detrimental infectious rates or graft outcomes at 1 year. Further study into risk factors and mechanism is warranted.1.Durack D, Street A. Fever of unknown origin–reexamined and redefined. In: Remington J, Swartz M, et al. Current clinical topics in infectious diseases. Volume 20. Blackwell Scientific Publications;1991;p:35–51.

CITATION INFORMATION: Klasek R, Kuten S, Patel S, Nguyen D, Graviss E, Gaber A, Knight R. The Incidence and Outcomes of Fever of Unknown Origin After Pancreas Transplantation. Am J Transplant. 2017;17 (suppl 3).

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