Although stable transplant recipients enjoy adequate allograft function, and an immunologic steady (or at least meta-stable) state, development of new medical problems and/or the requirement for new interventions to remedy those problems, threaten their precarious homeostasis. Resolution of acute medical challenges without disturbing the immunologic "status quo" is best accomplished under the direction of physicians with specific expertise managing immunosuppressed transplant recipients. Surgical intervention (elective or emergent) should be undertaken, whenever possible by individuals experienced in the care and management of these challenging patients. Beyond application of the general principles of good patient care, it is important to evaluate new problems within the context of the transplant recipient's immunosuppressed state, to anticipate factors which might impact transplant organ function, to ensure the appropriate use of antibiotics, and to maintain proper immunosuppression. This discussion will review various surgical illnesses commonly faced by transplant recipients, and specific management points will be considered.

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