Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients.
Acute Kidney Injury
/ epidemiology
Aged
Cytomegalovirus
/ physiology
Disease Progression
Female
France
/ epidemiology
HLA Antigens
/ immunology
Herpesvirus 4, Human
/ physiology
Hospital Mortality
Humans
Immunosuppressive Agents
/ therapeutic use
Infections
/ epidemiology
Intensive Care Units
Isoantibodies
/ blood
Kidney Transplantation
Male
Massive Hepatic Necrosis
/ mortality
Middle Aged
Neoplasms
/ mortality
Renal Insufficiency, Chronic
/ epidemiology
Retrospective Studies
Shock, Cardiogenic
/ mortality
Stroke
/ mortality
Transplant Recipients
Viremia
/ mortality
Virus Replication
HLA immunization
Intensive care unit
Outcomes
Renal transplantation
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
17 07 2019
17 07 2019
Historique:
received:
25
01
2019
accepted:
05
07
2019
entrez:
19
7
2019
pubmed:
19
7
2019
medline:
9
4
2020
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31315561
doi: 10.1186/s12871-019-0800-0
pii: 10.1186/s12871-019-0800-0
pmc: PMC6637509
doi:
Substances chimiques
HLA Antigens
0
Immunosuppressive Agents
0
Isoantibodies
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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