Sepsis in transplanted patients: beyond antibiotic therapy

Severe sepsis in transplant recipients results in an extremely high morbidity mortality rate. Microvascular alterations play an important role in the development of sepsis-induced organ dysfunction. Therefore, addition to standard treatment, which we divide into prophylaxis, preemptive therapy, and therapy, activated protein C (or Drotrecogin Alpha Activated [DAA]) represents a radically new approach for these patients. Herein we have reported the first trials evaluating the use of DAA in transplant recipients experiencing sepsis. Comparable trials in humans are still not available for the other coagulation, inhibitor antithrombin. We also report clinical trials discussing whether hyperimmune products reduce the infection rate during myelosuppression, but further trials are requested for the feasible evaluation of these products.