Outcome of Renal Transplant Recipients Admitted to an Intensive Care Unit: A 10-Year Cohort Study

Klouche, Kada; Amigues, Laurent; Massanet, P.; Garrigue, Valérie; Delmas, Sylvie; Szwarc, Ilan; Béraud, J. J.; Mourad, Georges

doi:10.1097/tp.0b013e31819a688a

Cited by 38 publications

(58 citation statements)

References 26 publications

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“…This finding is no different from other studies in this population, which report severe pulmonary complications more frequently after 6 months of transplantation, 8,9,16,18,23,24,27 although there are cases with different results. 17,28 Cardiogenic pulmonary edema is another condition often implicated in the genesis of ARF.…”

Section: Discussioncontrasting

confidence: 70%

“…7 Acute respiratory failure (ARF) is one of the most severe manifestations of pulmonary involvement, accounting for about half of hospitalizations in intensive care units (ICUs). [8][9][10] Bacterial and opportunistic infections are common causes of ARF, and are also factors associated with in-hospital mortality. 8 The epidemiological characteristics of ARF may be influenced by regional aspects.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

Silva

Freitas

Bafi

et al. 2017

Jornal Brasileiro De Nefrologia

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Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

Silva

Freitas

Bafi

et al. 2017

Jornal Brasileiro De Nefrologia

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“…Previous studies have reported varied rates of ICU admissions, ranging from 1% to 25%, 3 with discrepancies being attributed to differences in organization of surveillance between referring centers and transplant centers and individual policies regarding criteria for ICU admissions. 4 The donor population is also reflecting upward age trends, with more marginal kidneys and with associated comorbidities being included. In addition, as the age of transplant recipients is increasing with more associated comorbidities, the rate of ICU admissions may increase.…”

Section: Discussionmentioning

confidence: 99%

“…4,13 Sadaghdar and associates demonstrated that history of cardiac disease was the most frequent reason for immediate postoperative ICU admission among kidney transplant recipients, whereas sepsis was the 44 major reason for later ICU admissions. In addition, in line with our findings, they reported a better hospital outcome in the group 1 patients with a low mortality rate of 3.7% (0% in our study) and a short mean ICU stay of 5.1 days (3.7 days in our study).…”

Section: Discussionmentioning

confidence: 99%

Untitled

Okidi

Dellen²,

Sobajo³

et al. 2017

Exp Clin Transplant

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Objectives: Kidney transplant is the gold standard for treatment of renal failure. With the increasing age of the recipient population, which carries significant comorbidities, and the use of more marginal organs, there is potential for increased critical care admissions. In this study, we investigated the incidence, indications, and outcomes of patients admitted to critical care within 1 year of transplant. We also aimed to identify any precipitating factors or events that may trigger these admissions, as well as establish variables that could affect mortality. Materials and Methods:We performed a retrospective analysis of kidney transplant recipients admitted to critical care within 1 year after transplant, between January 2009 and December 2013. Results: Of 1002 kidney transplants, 53 patients (5.3%) were admitted to critical care within 1 year, with patients separated into 2 groups. Group 1 comprised 32 patients (61%) who were admitted immediately postoperatively, mainly from cardiorespiratory derangements with mean stay of 3.7 days (range, 1-34 days) and 0 mortalities. Group 2 comprised 21 patients (39%) who were admitted later in the postoperative period, principally from sepsis-related complications with a mean stay of 18 days (range, 1-101 days). Most patients in group 2 required intensive therapy, including mechanical ventilation and immunosuppression reduction, incurring a hospital mortality rate of 48%. Hemorrhage with reexploration was higher in group 1. Diabetes mellitus, cardiac comorbidity, prolonged stay, nutritional support, nosocomial infections, and multiple organ failure were found at a higher rate in the group 2 patients who died. Conclusions:The incidence of critical care admissions 1 year after kidney transplant was 5.3%. Most admissions occurred in the early postoperative period, mostly as preemptive measures for cardiorespiratory monitoring and support. This category of admission is potentially preventable with optimization of preoperative treatment. Later admissions were mostly consequential to sepsis-related complications, with patients having a high mortality rate due to multiple organ failure. Clinical management should therefore focus on the prevention of multiple organ failure to improve patient outcomes.

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“…Sudden decrease in urine output may warrant surgical re-exploration [11]. Transplanted patients requiring prolonged mechanical ventilation postoperatively, have a worse outcome compared with patients who were extubated at the end of surgery [55]. Post-operative pain relief is essential after renal transplantation, as inadequately controlled pain can lead to agitation, tachycardia, hypertension and an increased risk of pulmonary complications.…”

Section: Postoperative Carementioning

confidence: 99%