Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit

Freitas, Flávio Geraldo Rezende; Lombardi, Fábio; Pacheco, Eduardo Souza; Sandes‐Freitas, Tainá Veras de; Viana, Laila Almeida; Tedesco‐Silva, Hélio; Medina-Pestana, José; Bafi, Antônio Tonete; Machado, Flávia Ribeiro

doi:10.1177/1526924817746685

Cited by 9 publications

(14 citation statements)

References 43 publications

(69 reference statements)

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“…Studies from the other parts of the world included multiorgan transplant recipients and ICU admissions long after kidney transplant. 9 , 10 , 11 , 12 , 13 , 14 , 15 The ICU mortality rate varies from 12.8% to as high as 42.6% in these studies. 9 , 10 , 12 , 13 , 14 , 15 The risk profile of multiorgan recipients is different from that of solitary kidney transplant recipients.…”

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confidence: 77%

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Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study

Abrol

Kashyap

Kashani

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To study the characteristics and outcomes of a cohort of kidney transplant recipients who required high-acuity care after transplant surgery. Patients and Methods: All adult (aged !18 years) solitary kidney transplant recipients from January 1, 2007, through December 31, 2016, were screened and those who required high-acuity care within the same hospitalization were enrolled. Patient demographic and clinical data were collected from the departmental database and electronic DataMart. Results: Of 1525 patients, 266 (17.4%) required high-acuity care after the kidney transplant operation: 166 (62.4%) directly from the operating room and 100 (37.6%) after an interval during the same hospitalization. Overall, 2 main indications were hypotension (n¼87; 32.7%) and cardiac rhythm disturbances (n¼83; 31.2%). Recipients in the direct admission group had higher medium body mass index (31.0 [interquartile range, 26.6-36.0] vs 28.0 [interquartile range, 24.3-32.4] kg/m 2 ; P<.001) and were more likely to have undergone a concomitant procedure with the transplant surgery. Overall, in-hospital mortality was 1.9% (n¼5). Conclusion: In contemporary practice, patients with higher body mass index are more likely to require high-acuity care immediately after kidney transplant surgery. The most common reasons are hypotension and cardiac rhythm disorders. The overall intensive care unit mortality rate of these patients is low. However, these patients are at risk for graft loss and death in the long term compared with patients who do not require intensive care unit care after transplant surgery.

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confidence: 77%

“…[9][10][11][12][13][14][15] The ICU mortality rate varies from 12.8% to as high as 42.6% in these studies. 9,10,[12][13][14][15] The risk profile of multiorgan recipients is different from that of solitary kidney transplant recipients. Similarly, delayed ICU admissions after kidney transplant are mainly due to respiratory failure or sepsis.…”

mentioning

confidence: 99%

Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study

Abrol

Kashyap

Kashani

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…This aspect has rarely been addressed so far. To the best of our knowledge, only three working groups have stratified their data for ICU admission [ 27 , 28 , 29 ]. Two working groups focused on ICU admission at any time after KT, even years after KT, which clearly does not help when trying to decide whether or not to perform a KT during the present SARS-CoV-2 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Should We Perform Old-For-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay

Zeuschner

Sester

Stöckle

et al. 2020

JCM

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Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.

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“…Some may require intensive or high dependency care postoperatively which may not be possible during the COVID-19 pandemic [20]. In-depth counselling with the patient about the risks is essential.…”

Section: Renal Transplantmentioning

confidence: 99%

Where do urologists stand in the era of novel coronavirus-2019 disease

Hughes

Shariat³

et al. 2020

Current Opinion in Urology

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Purpose of review The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption. Recent findings Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category.

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Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit

Abstract: Sepsis was the main reason for ICU admission in kidney transplant recipients, followed by cardiovascular disease. Age and disease severity were associated with hospital mortality.

Cited by 9 publications

References 43 publications

Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study

Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study

Should We Perform Old-For-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay

Where do urologists stand in the era of novel coronavirus-2019 disease

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