Course and Outcome of Renal Transplant Recipients Admitted to the Intensive Care Unit (ICU): Long Term Follow-up

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Abstract

Background

The goal of this study was to evaluate the course and outcome of renal transplant recipients admitted to ICU and to analyze factors determining prognosis and mortality.

Methods

We reviewed the data of all adult renal transplant recipients who were admitted to the ICU at our center, between 1997 and 2017 which included the demographic features, data admission characteristics, and ICU courses. Among 379 consecutive kidney transplants followed up in our center, 60 patients were re-admitted to ICU and were categorized to early (during first 3 months; n=28); intermediate (3–12 months; n=7); and late (12 months and afterwards, n=25).

Results

The mean age was 48.3 ± 12.6 years and 68% were males. The causes of ICU admissions were surgical complication (71%) and infection (18%) in early phase, infection (57%) and cardiovascular complications (28%) in intermediate phase, and infection (68%) and respiratory complications (12%) in late phase. Mortality after discharge was significantly higher in late admission (78.6%) (p=0.002). Twenty patients during their ICU stay required ventilator. When compared to kidney transplant patients not admitted to ICU, only 35% vs 74% still have functioning grafts at the last follow-up (p=0.0001) and main cause of graft loss was death with function grafts (36.7% vs 13.7%). The overall graft survival rates were 97%, 80%, and 74% at 1 year, 3 years, and 5 years, respectively. Patient survival rates at these times were 86%, 82%, and 74%, respectively. In multivariate analysis, we found only the age and need for ventilator during the ICU as an independent risk factor for mortality (P < 0.02).

Conclusion

We found in this study that the main reason for ICU admissions among renal transplant recipients was infections. Mortality rates for this particular population are relatively high and are primarily linked to need for ventilators.

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