The relationship between fever and acute rejection or infection following renal transplantation in the cyclosporin era.

In the past, fever has been considered to be an important sign of rejection in renal transplant patients but since the introduction and widespread use of cyclosporin this relationship has become less clear. We have studied the relationship between fever defined as a single temperature reading > or = 38.5 degrees C or recordings > or = 38.0 degrees C over 2 consecutive days, and acute rejection or infection in 99 consecutive renal transplants. Within the first 6 months after transplantation 90 acute rejection episodes were recorded in 61 patients and most (83%) were not associated with fever. Forty-seven episodes of fever were documented in 37 patients and ascribed to acute rejection (15), infection (17), antibody therapy (11) or other causes (4). Fever in the first 16 days was significantly more likely to be due to rejection than to infection (chi 2 = 24.47, p = < 0.001). Episodes of fever due to infection tended to occur after the 1st month, coincident with the peak incidence of cytomegalovirus (CMV) infection. However, with the exception of CMV disease, fever was not a reliable guide for the presence of infection, including septicemia.