The Critically Ill Kidney Transplant Recipient: a narrative review.
Chest. 2016 Jan 18;
Authors: Canet E, Zafrani L, Azoulay É
Kidney transplantation is the most common solid organ transplantation performed worldwide. Up to 6% of kidney transplant recipients experience a life-threatening complication that requires ICU admission, chiefly in the late post-transplant period (≥6 months). Acute respiratory failure and septic shock are the main reasons for ICU admission. Cardiac pulmonary edema, bacterial pneumonia, acute graft pyelonephritis, and bloodstream infections account for the vast majority of the diagnoses in the ICU. Pneumocystis jirovecii pneumonia is the most common opportunistic infection and requires mechanical ventilation in half the cases. Incidence of cytomegalovirus visceral infections in the era of preemptive therapy has dramatically decreased. Drug-related neutropenia, sirolimus-related pneumonitis, and posterior reversible encephalopathy syndrome are among the most common immunosuppressive associated toxic effects. Importantly, the impact of critical illness on graft function is worrisome. Throughout the ICU stay, acute kidney injury is common, and about 40% of the recipients require renal replacement therapy. Half of the patients are discharged alive and free from dialysis. Hospital mortality can reach 30% and correlates with acute illness severity and reason for ICU admission. Transplant characteristics are not predictors of short term survival. Graft survival depends on pre-ICU graft function, disease severity and renal toxicity of ICU investigations and treatments.
PMID: 26836919 [PubMed - as supplied by publisher]