Premium
Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome
Author(s) -
Bige N.,
Zafrani L.,
Lambert J.,
Peraldi M.N.,
Snanoudj R.,
Reuter D.,
Legendre C.,
Chevret S.,
Lemiale V.,
Schlemmer B.,
Azoulay E.,
Canet E.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12249
Subject(s) - medicine , intensive care unit , sepsis , odds ratio , urinary system , renal replacement therapy , septic shock , renal function , pneumonia , mechanical ventilation , sofa score , confidence interval , transplantation , kidney transplantation , intensive care medicine
Background Kidney transplant recipients are at risk for life‐threatening infections, which may affect the long‐term prognosis. Methods We retrospectively included all kidney transplant recipients admitted for sepsis, severe sepsis, or septic shock to the medical intensive care unit ( ICU ) of the Saint‐Louis Hospital, Paris, France, between 2000 and 2010. The main objective was to identify factors associated with survival without graft impairment 90 days after ICU discharge. Results Data were available for 83 of 100 eligible patients. The main sites of infection were the lungs (54%), urinary tract (24%), and bloodstream (22%). Among documented infections (55/83), 80% were bacterial. Fungal infections were more common among patients transplanted after 2005 (5% vs. 23%, P = 0.02). Mechanical ventilation was used in 46 (56%) patients, vasopressors in 39 (47%), and renal replacement therapy ( RRT ) in 34 (41%). In‐hospital and day‐90 mortality rates were 20% and 22%, respectively. On day 90, among the 65 survivors, 39 (47%) had recovered their previous graft function and 26 (31%) had impaired graft function, including 16 (19%) who were dependent on RRT . Factors independently associated with day‐90 survival and graft function recovery were baseline serum creatinine (odds ratio [ OR ] for a 10 μmol/L increase 0.94, 95% confidence interval [ CI ] 0.88–1.00) and cyclosporine therapy ( OR 0.30, 95% CI 0.11–0.79). Conclusion Sepsis was chiefly related to bacterial pneumonia or urinary tract infection. P neumocystis jirovecii was the leading opportunistic agent, with a trend toward an increase over time. Infections often induced severe graft function impairment. Baseline creatinine and cyclosporine therapy independently predicted the outcome.