Outcome of renal transplant recipients and graft survival in the ICU

Objective

To determine renal transplant recipients outcome and graft survival in ICU setting.

Design

Retrospective cohort study.

Setting

Ten-bed adult medical ICU in a university hospital.

Patients

Consecutive adult renal transplant recipients admitted to an ICU over a period of 13 years. In our institution postoperative monitoring is not performed in ICU.

Measurements

For each patient the following data were recorded: demographic characteristics, prior duration of transplantation, immunosuppressive therapy, indications for admission to ICU, data necessary for the calculation of SAPS II and APACHE II, duration of mechanical ventilation, length of stay in ICU, mortality and graft survival at both ICU and hospital discharge. Patient and graft survival were also collected 6 months after ICU discharge.

Results

Thirty ICU admissions in 26 adult renal transplant recipients were studied. The median of prior post-transplant duration was 3 months (10 days–90 months), and of end-stage renal disease was 68 months (5–340). Reasons for admission were: sepsis (n = 11), hemorrhage (n = 4), cardiopathy/fluid overload (n = 4), coma (n = 4), abdominal crisis (n = 4), others (n = 3). The overall ICU mortality was 33%. There was no difference between the observed hospital mortality (40%) and the expected mortality as predicted by SAPS II (36.6%) or APACHE II (50%). The area under the receiver operating characteristic curve was 0.85 ± 0.08 for SAPS II and 0.84 ± 0.08 for APACHE II. The variables associated with ICU mortality were: (i) ICU admission without hospital discharge after transplantation (RR = 2.5), (ii) mechanical ventilation requirement (RR > 20), (iii) vasoactive drugs use (RR = 5.6). Use of immunosuppressive drugs was not different between survivors and nonsurvivors. At ICU discharge, graft survival among survivors was 48%. At 6 months, 5 additional renal transplant recipients had died.

Conclusion

The mortality of renal transplant recipients admitted in ICU is high and graft loss during ICU stay is frequent.