Septic shock occurs frequently in solid organ transplant (SOT) recipients. Standard
therapy includes fluid
resuscitation, the administration of antimicrobials, and source control of the
infection. Adjunctive
therapy with recombinant human activated
protein C (
rhaPC), also called drotrecogin alpha, is another treatment that is used in patients but has not been studied in SOT patients. Concerns regarding the use of this
drug in this patient population include the risk of
bleeding and the potential to adversely affect graft survival. Here we report the largest case series of SOT recipients with
septic shock who received
rhaPC. This was a retrospective chart review that looked at the impact of this
drug in the SOT population. In this single-center study, we identified 17 patients with a SOT and
septic shock who received
rhaPC. Six of the patients underwent kidney transplants, 5 received lung transplants, 4 received cadaveric
liver transplants, and 2 received combined kidney/pancreas transplants. The average APACHE II score was 26.6 ± 5.5; all patients were undergoing
mechanical ventilation and receiving vasopressors at the time of
rhaPC administration. Overall mortality in the group was 23.5% (4/17) at 28 days post infusion. All of the deaths were due to complications of
septic shock. Allograft survival was present in 13/17 (76.5%) of the patients at 28 days.
Bleeding occurred in 17.6% of patients (3/17). The use of
rhaPC appears to be associated with a favorable effect on mortality, with the potential for increased risk of
bleeding. Clinicians must balance this risk with the potential benefit of this
drug until further research can be conducted.