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Ulas, Aydin; Kaplan, Şerife; Zeyneloğlu, Pınar; Pirat, Arash; Haberal, Mehmet

doi:10.6002/ect.tdtd2015.o37

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…Over the study period, the estimated incidence of ICU admission (7.7%) was closed to the one reported in recent studies (4.5 to 10.2%) [2–5, 7]. Median time from renal transplantation to ICU admission was longer (41 months vs. 4.4 to 25.2 months [1–5, 7–9, 18]) except in one study [19].…”

Section: Discussionmentioning

confidence: 77%

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Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients

Guinault¹,

Bello²,

Lavayssière³

et al. 2019

BMC Anesthesiol

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Background Risk of over-immunosuppression or immunization may mitigate the overall and long-term renal outcomes of kidney transplant recipients (KTR) admitted to the ICU in the modern era but remain poorly described. Thus, there is an unmet need to better characterize the survival of KTR admitted to the ICU, but also the renal and immunological outcomes of survivors. Methods Retrospective observational study that included 200 KTR admitted between 2010 and 2016 to the ICU of a teaching hospital (median age 61 years [IQR 50.7–68]; time from transplantation 41 months [IQR 5–119]). Survival curves were compared using the Log-rank test. Results Mortality rates following admission to the ICU was low (26.5% at month-6), mainly related to early mortality (20% in-hospital), and predicted by the severity of the acute condition (SAPS2 score) but also by Epstein Barr Virus proliferation in the weeks preceding the admission to the ICU. Acute kidney injury (AKI) was highly prevalent (85.1%). Progression toward chronic kidney disease (CKD) was observed in 45.1% of survivors. 15.1% of survivors developed new anti-HLA antibodies (donor-specific antibodies 9.2% of cases) that may impact the long-term renal transplantation function. Conclusions Notwithstanding the potential biases related to the retrospective and monocentric nature of this study, our findings obtained in a large cohort of KTR suggest that survival of KTR admitted in ICU is good but in-ICU management of these patients may alter both survival and AKI to CKD transition, as well as HLA immunization. Further interventional studies, including systematic characterization of the Epstein Barr virus proliferation at the admission (i.e., a potential surrogate marker of an underlying immune paralysis and frailty) will need to address the optimal management of immunosuppressive regimen in ICU to improve survival but also renal and immunological outcomes.

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Section: Discussionmentioning

confidence: 77%

“…About 10% of kidney transplant recipients (KTR) experience a life-threatening disease requiring admission in an intensive care unit (ICU) [1–7] . Most admissions occur more than 6 months after the renal transplantation [3–5, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients

Guinault¹,

Bello²,

Lavayssière³

et al. 2019

BMC Anesthesiol

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“…Most of our study's patients admitted to ICU were more than 6 months after transplantation. Like pediatric RT recipients, most adult RT recipients are also admitted to the ICU > 6 months after RT [10,12,[20][21][22]. This situation can be associated with the effectiveness of the current preventive practices (vaccination, prophylaxis, preemptive therapies) applied before RT and during the first 6 months posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…Acute respiratory failure and sepsis are the main causes of ICU admission in adult RT recipients [10,12,[20][21][22]25]. There are multiple reasons for acute respiratory failure in adult RT recipients [10,12].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pediatric renal transplant recipients admitted to the intensive care unit: A retrospective cohort study

Yeşiler¹,

Kaya²,

Şahintürk³

et al. 2023

J Surg Med

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Background/Aim: The best course of treatment for children with end-stage kidney disease (ESKD) is renal transplantation (RT), but some pediatric RT recipients are admitted to an intensive care unit (ICU) post-transplant. In the early and late post-operative phases, clinical data about pediatric RT recipients who are admitted to ICU are available. In this study, we aimed to evaluate demographic features, main reasons, and outcomes of pediatric RT patients admitted to the ICU during the early and late post-operative phases. Methods: This study was a cohort study. We analyzed the medical records of pediatric RT recipients (<18 years of age) who were admitted to the ICU between May 30, 2011, and October 16, 2021, at our center, retrospectively. Patients ≥18 years of age and those without available data were excluded. We obtained the following data from ICU follow-up records and hospital medical records. The median (minimum-maximum) for continuous variables, frequencies, and percentages for categorical variables were used. The Chi-square test was used to compare categorical variables. We created graphs using percentages and frequencies to summarize the results. Results: Nineteen (16.5%) of the 115 pediatric patients who underwent RT were admitted to the ICU during the study period. Thirteen patients (68.4%) were male, and the mean age was 10.2 (4.9) years. Hypertension (21.2%) was the most common comorbidity. Eighteen (94.7%) received transplants from living donors. Cystic-hereditary-congenital disorders (42.1%, n=8) and congenital anomalies of the kidney and urinary tract (26.3%, n=5) were among the etiologies of ESKD. Ten patients (52.6%) were admitted to the ICU >6 months after transplantation. Epileptic seizure (n=6, 31.6%), respiratory failure (n=4, 21.1%), and cardiac diseases (n=2, 10.5%) were among the main reasons for ICU admission. During ICU follow-up, invasive mechanical ventilation was needed for five patients (26.3%), and renal replacement treatment was needed for four patients (21.1%). The mean length of ICU was 12.4 (28.5), and the mean hospital stay was 25.8 (29.4) days. The ICU and hospital survival rates were 78.9% and 97%, respectively, while 3.5% was the hospital mortality rate. Hemorrhagic cerebrovascular disease, acute hepatic failure, and cardiogenic shock secondary to pericardiocentesis were the causes of death in the ICU. Conclusion: Patients mostly had ICU admissions because of epileptic seizures and acute respiratory failure. A multidisciplinary approach involving pediatric nephrologists, transplant surgeons, and an intensive care team successfully manages pediatric RT recipients admitted to the intensive care unit.

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“…Pulmonary complications are one of the major causes of death in kidney transplant recipients [1,2]. Their frequency varies from 3.1% to 37% with a mortality rate of 22.5% to 32% [3–5].…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Takahashi

Stone

et al. 2017

Am J Case Rep

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Patient: Male, 50Final Diagnosis: Pulmonary fibrosisSymptoms: Short of breathMedication: —Clinical Procedure: —Specialty: TransplantologyObjective:Adverse events of drug therapyBackground:Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associated with MMF after kidney transplantation.Case Report:A 50-year-old Hispanic male with a history of end-stage renal disease secondary to hypertension underwent deceased donor kidney transplantation. His preoperative evaluations were normal except for a chest x-ray which showed bilateral interstitial opacities. Tacrolimus and MMF were started on the day of surgery. His postoperative course was uneventful and he was discharged on postoperative day 5. One month later, he presented with shortness of breath and a cough with blood-tinged sputum. His respiratory condition deteriorated rapidly, requiring intubation. Chest computer tomography (CT) demonstrated patchy ground-glass opacities with interlobular septal thickening. Comprehensive pulmonary, cardiac, infectious, and immunological evaluations were all negative. Open lung biopsy revealed extensive pulmonary fibrosis with no evidence of infection. He temporarily improved after discontinuation of tacrolimus and MMF, however, on resuming MMF his respiratory status deteriorated again and he subsequently died from hypoxic respiratory failure.Conclusions:An awareness of pulmonary lung disease due to MMF is important to prevent adverse outcomes after organ transplantation. MMF must be used with utmost care in recipients with underlying lung disease as their pulmonary condition might make them more susceptible to any harmful effects of MMF.

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Untitled

Cited by 4 publications

References 6 publications

Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients

Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients

Evaluation of pediatric renal transplant recipients admitted to the intensive care unit: A retrospective cohort study

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

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