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 ad...
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doaj-4e397e98f3ba4029a381a6bb52baf2032020-11-25T03:12:00ZengBMCBMC Anesthesiology1471-22532019-07-011911910.1186/s12871-019-0800-0Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patientsDamien Guinault0Arnaud Del Bello1Laurence Lavayssiere2Marie-Béatrice Nogier3Olivier Cointault4Nicolas Congy5Laure Esposito6Anne-Laure Hebral7Olivier Roques8Nassim Kamar9Stanislas Faguer10Département de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseLaboratoire d’Immunologie, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseDépartement de Néphrologie et Transplantation d’organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de ToulouseAbstract 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.http://link.springer.com/article/10.1186/s12871-019-0800-0Renal transplantationHLA immunizationIntensive care unitOutcomes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Damien Guinault Arnaud Del Bello Laurence Lavayssiere Marie-Béatrice Nogier Olivier Cointault Nicolas Congy Laure Esposito Anne-Laure Hebral Olivier Roques Nassim Kamar Stanislas Faguer |
spellingShingle |
Damien Guinault Arnaud Del Bello Laurence Lavayssiere Marie-Béatrice Nogier Olivier Cointault Nicolas Congy Laure Esposito Anne-Laure Hebral Olivier Roques Nassim Kamar Stanislas Faguer Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients BMC Anesthesiology Renal transplantation HLA immunization Intensive care unit Outcomes |
author_facet |
Damien Guinault Arnaud Del Bello Laurence Lavayssiere Marie-Béatrice Nogier Olivier Cointault Nicolas Congy Laure Esposito Anne-Laure Hebral Olivier Roques Nassim Kamar Stanislas Faguer |
author_sort |
Damien Guinault |
title |
Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
title_short |
Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
title_full |
Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
title_fullStr |
Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
title_full_unstemmed |
Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
title_sort |
outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2019-07-01 |
description |
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. |
topic |
Renal transplantation HLA immunization Intensive care unit Outcomes |
url |
http://link.springer.com/article/10.1186/s12871-019-0800-0 |
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