Abstract
IntroductionData on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients.MethodsWe conducted a retrospective observational study in nine transplant centers of consecutive kidney transplant recipients admitted to the intensive care unit (ICU) for ARF from 2000 to 2008.ResultsOf 6,819 kidney transplant recipients, 452 (6.6%) required ICU admission, including 200 admitted for ARF. Fifteen (7.5%) of these patients had combined kidney-pancreas transplantations. The most common causes of ARF were bacterial pneumonia (35.5%), cardiogenic pulmonary edema (24.5%) and extrapulmonary acute respiratory distress syndrome (ARDS) (15.5%). Pneumocystis pneumonia occurred in 11.5% of patients. Mechanical ventilation was used in 93 patients (46.5%), vasopressors were used in 82 patients (41%) and dialysis was administered in 104 patients (52%). Both the in-hospital and 90-day mortality rates were 22.5%. Among the 155 day 90 survivors, 115 patients (74.2%) were dialysis-free, including 75 patients (65.2%) who recovered prior renal function. Factors independently associated with in-hospital mortality were shock at admission (odds ratio (OR) 8.70, 95% confidence interval (95% CI) 3.25 to 23.29), opportunistic fungal infection (OR 7.08, 95% CI 2.32 to 21.60) and bacterial infection (OR 2.53, 95% CI 1.07 to 5.96). Five factors were independently associated with day 90 dialysis-free survival: renal Sequential Organ Failure Assessment (SOFA) score on day 1 (OR 0.68/SOFA point, 95% CI 0.52 to 0.88), bacterial infection (OR 0.43, 95% CI 0.21 to 0.90), three or four quadrants involved on chest X-ray (OR 0.44, 95% CI 0.21 to 0.91), time from hospital to ICU admission (OR 0.98/day, 95% CI 0.95 to 0.99) and oxygen flow at admission (OR 0.93/liter, 95% CI 0.86 to 0.99).ConclusionsIn kidney transplant recipients, ARF is associated with high mortality and graft loss rates. Increased Pneumocystis and bacterial prophylaxis might improve these outcomes. Early ICU admission might prevent graft loss.
Highlights
Data on pulmonary complications in renal transplant recipients are scarce
Renal transplant recipients may be at increased risk for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), most notably in the event of graft failure or antilymphocyte globulin therapy for rejection [23]
Acute respiratory failure (ARF) compromises short- and longterm outcomes [22], few studies have assessed the need for intensive care unit (ICU) management in kidney transplant recipients with acute respiratory failure (ARF)
Summary
Data on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients. Over the past two decades, the development of new immunosuppressive drugs [3] and advances in the These advances have prompted increased use of kidney transplantation and substantial broadening of eligibility criteria for both donors and recipients [10,11,12,13,14]. In addition to long history of chronic renal disease and dialysis, kidney transplant recipients often have severe comorbidities (for example, cardiovascular disease and diabetes) that are associated with specific immune deficiencies [2]. This combination of problems leads to complications, many of which involve the lungs [21,22]. Acute respiratory failure (ARF) compromises short- and longterm outcomes [22], few studies have assessed the need for intensive care unit (ICU) management in kidney transplant recipients with ARF
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