Etiologies and Outcomes of Acute Respiratory Failure in Solid Organ Transplant Recipients: Insight Into the EFRAIM Multicenter Cohort.

Aged Cohort Studies Female Humans Male Middle Aged Organ Transplantation / adverse effects Postoperative Complications / etiology Prospective Studies Respiratory Insufficiency / etiology Transplant Recipients

Journal

Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532

Informations de publication

Date de publication:
Dec 2020
Historique:
received: 03 02 2020
accepted: 23 02 2020
pubmed: 6 6 2020
medline: 16 2 2021
entrez: 6 6 2020
Statut: ppublish

Résumé

Respiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU. In this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1. Among 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis. ICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated.

Sections du résumé

BACKGROUND BACKGROUND
Respiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU.
METHODS METHODS
In this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1.
RESULTS RESULTS
Among 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis.
CONCLUSIONS CONCLUSIONS
ICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated.

Identifiants

DOI: 10.1016/j.transproceed.2020.02.170 PMID: 32499142
pubmed: 32499142
pii: S0041-1345(20)30083-X
doi: 10.1016/j.transproceed.2020.02.170
pii:
doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

2980-2987

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Auteurs

Jonathan Messika (J)

Pulmonology and Lung Transplant Unit, Hôpital Bichat-Claude Bernard, APHP.Nord- Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, Paris Transplant Group, F-75018 Paris, France. Electronic address: jonathan.messika@aphp.fr.

Michael Darmon (M)

Medical Intensive Care Unit, Hôpital Saint-Louis, APHP.Nord-Université de Paris ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM Paris Diderot Sorbonne University, Paris, France.

Hervé Mal (H)

Pulmonology and Lung Transplant Unit, Hôpital Bichat-Claude Bernard, APHP.Nord- Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, Paris Transplant Group, F-75018 Paris, France.

Peter Pickkers (P)

Department of Intensive Care Medicine (710), Radboud University Medical Center, Nijmegen, The Netherlands.

Marcio Soares (M)

Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação em Clínica Médica, Rio De Janeiro, Brazil.

Emmanuel Canet (E)

Medical Intensive Care Unit, Hôtel Dieu-HME University Hospital of Nantes, Nantes, France.

Jordi Rello (J)

Centro de Investigacion Biomedica en Red - CIBERES & Vall d'Hebron Institute of Research, Barcelona, Spain.

Philippe R Bauer (PR)

Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States.

Andry van de Louw (A)

Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, Pennsylvania, United States.

Virginie Lemiale (V)

Medical Intensive Care Unit, Hôpital Saint-Louis, APHP.Nord-Université de Paris ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM Paris Diderot Sorbonne University, Paris, France.

Fabio Silvio Taccone (FS)

Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Ignacio Martin Loeches (IM)

Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland, and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.

Peter Schellongowski (P)

Department of Medicine I, Medical University of Vienna, Vienna, Austria.

Sangeeta Mehta (S)

Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.

Massimo Antonelli (M)

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Achille Kouatchet (A)

Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France.

Andreas Barratt-Due (A)

Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.

Miia Valkonen (M)

Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Fabrice Bruneel (F)

Medical-Surgical Intensive Care Unit, André Mignot Hospital, CH Versailles, Le Chesnay, France.

Frédéric Pène (F)

Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France.

Victoria Metaxa (V)

King's College Hospital, London, United Kingdom.

Anne Sophie Moreau (AS)

Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France.

Gaston Burghi (G)

Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay.

Luca Montini (L)

Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France.

François Barbier (F)

Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France.

Lene B Nielsen (LB)

Department of Intensive Care, University of Southern Denmark, Odense, Denmark.

Djamel Mokart (D)

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmette, Marseille, France.

Sylvie Chevret (S)

ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Paris, France.

Lara Zafrani (L)

Medical Intensive Care Unit, Hôpital Saint-Louis, APHP.Nord-Université de Paris ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM Paris Diderot Sorbonne University, Paris, France.

Elie Azoulay (E)

Medical Intensive Care Unit, Hôpital Saint-Louis, APHP.Nord-Université de Paris ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM Paris Diderot Sorbonne University, Paris, France.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Procédures de chirurgie opératoire › Transplantation › Transplantation d'organe › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Troubles respiratoires › Insuffisance respiratoire › Etiologies and Outcomes of Acute Respiratory...
questionsmedicales.fr › Personnes › Receveurs de transplantation › Etiologies and Outcomes of Acute Respiratory...