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

Abstract

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.

A Case of Short- Term Intensive Care Unit-Acquired Weakness Post-Renal Graft Nephrectomy after Liver and Kidney Transplant

“…Patient has poor function of the donor kidney; one article proves the poor outcomes of kidney transplant recipients [16]. She underwent renal graft nephrectomy three months later and was on dialysis three times/week.…”

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

“…Therefore, hypotension, cardiopulmonary monitoring, and cardiac rhythm disorders were the main indications in our cohort compared with sepsis, acute respiratory failure, and malignancy in other studies. 11,13,15,16 The characteristics and outcomes of transplant recipients who are admitted due to sepsis, acute respiratory failure, or other indications months or years after transplant surgery are inherently different from the immediate postsurgery patients. Therefore, our results cannot be directly compared with previously published reports.…”

“…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.…”

“…Similarly, delayed ICU admissions after kidney transplant are mainly due to respiratory failure or sepsis. 11 This does not represent the risk due to kidney transplant surgery in this population. Therefore, there is a need to re-examine the characteristics and outcomes of kidney transplant recipients requiring ICU admission.…”

Solid organ transplant recipients during COVID-19 pandemic

“…We read with interest the correspondence from Montagud‐Marrahi et al 1 putting forward that solid organ transplant (SOT) recipients are not at higher risk of severe coronavirus disease 2019 (COVID‐19) infection despite their immunosuppression and the mild or atypical nature of their symptoms in their Spanish cohort. In the recent literature, this population achieves a mortality rate between 20% and 52% when they become critically ill 2,3 . (p) Moreover, as innate immunity is altered by the infection, decreased doses of immunosuppressive drugs should be considered 4,5 …”