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Evaluation of pediatric renal transplant recipients admitted to the intensive care unit: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background/Aim: The best course of treatment for children with end-stage kidney disease (ESKD) is renal transplantation (RT), but some pediatric RT recipients are admitted to an intensive care unit (ICU) post-transplant. In the early and late post-operative phases, clinical data about pediatric RT recipients who are admitted to ICU are available. In this study, we aimed to evaluate demographic features, main reasons, and outcomes of pediatric RT patients admitted to the ICU during the early and late post-operative phases.
Methods: This study was a cohort study. We analyzed the medical records of pediatric RT recipients (<18 years of age) who were admitted to the ICU between May 30, 2011, and October 16, 2021, at our center, retrospectively. Patients ≥18 years of age and those without available data were excluded. We obtained the following data from ICU follow-up records and hospital medical records. The median (minimum-maximum) for continuous variables, frequencies, and percentages for categorical variables were used. The Chi-square test was used to compare categorical variables. We created graphs using percentages and frequencies to summarize the results.
Results: Nineteen (16.5%) of the 115 pediatric patients who underwent RT were admitted to the ICU during the study period. Thirteen patients (68.4%) were male, and the mean age was 10.2 (4.9) years. Hypertension (21.2%) was the most common comorbidity. Eighteen (94.7%) received transplants from living donors. Cystic-hereditary-congenital disorders (42.1%, n=8) and congenital anomalies of the kidney and urinary tract (26.3%, n=5) were among the etiologies of ESKD. Ten patients (52.6%) were admitted to the ICU >6 months after transplantation. Epileptic seizure (n=6, 31.6%), respiratory failure (n=4, 21.1%), and cardiac diseases (n=2, 10.5%) were among the main reasons for ICU admission. During ICU follow-up, invasive mechanical ventilation was needed for five patients (26.3%), and renal replacement treatment was needed for four patients (21.1%). The mean length of ICU was 12.4 (28.5), and the mean hospital stay was 25.8 (29.4) days. The ICU and hospital survival rates were 78.9% and 97%, respectively, while 3.5% was the hospital mortality rate. Hemorrhagic cerebrovascular disease, acute hepatic failure, and cardiogenic shock secondary to pericardiocentesis were the causes of death in the ICU.
Conclusion: Patients mostly had ICU admissions because of epileptic seizures and acute respiratory failure. A multidisciplinary approach involving pediatric nephrologists, transplant surgeons, and an intensive care team successfully manages pediatric RT recipients admitted to the intensive care unit.
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Xu Y, Chao S, Niu Y. Association between the Predicted Value of APACHE IV Scores and Intensive Care Unit Mortality: A Secondary Analysis Based on EICU Dataset. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9151925. [PMID: 35432584 PMCID: PMC9007664 DOI: 10.1155/2022/9151925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 11/18/2022]
Abstract
Objective The evidence regarding the relationship between Acute Physiological and Chronic Health Assessment (APACHE) IV scores and emergency intensive care unit (EICU) mortality in patients following organ transplantation remains controversial. The purpose of this study was to investigate the relationship between APACHE IV score and EICU mortality. Methods Data from 391 American men and women admitted to the EICU after undergoing organ transplants including heart, bone marrow, liver, kidney, lung, and pancreas in the United States. We used this data to analyze the relationship between APACHE IV scores and in-hospital mortality in the postoperative EICU. The primary endpoint was ICU hospitalization mortality after organ transplantation. The entire study data was extracted from the EICU database and uploaded to the DataDryad website. Results Interaction tests indicate age, respiratory failure, and hormone use can modify the association between APACHE IV and EICU mortality. A stronger association of APACHE and mortality can be observed at <60 years old, no respiratory failure, and no use of hormones. In contrast, there was no association between respiratory failure, hormone use, APACHE, and ICU mortality in patients over 60 years of age. Conclusion When using the APACHE score for risk stratification of critically ill patients after transplantation, the patient's age, respiratory failure, and use of hormones should be taken into account.
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Affiliation(s)
- Yuan Xu
- Department of Organ Transplantation, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Sheng Chao
- Department of Organ Transplantation, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yulin Niu
- Department of Organ Transplantation, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
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Abrol N, Kashani KB, Prieto M, Taner T. A Descriptive Study of Late Intensive Care Unit Admissions After Adult Solitary Kidney Transplantation. Transplant Proc 2021; 53:1095-1099. [PMID: 33573818 DOI: 10.1016/j.transproceed.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/27/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Kidney transplant recipients are at lifetime risk of requiring high acuity care. In the current study, we aimed to assess the reasons for delayed (> 30 days) intensive care unit (ICU) admissions post-transplant and causes of ICU-related mortality. METHODS This is a retrospective study of a cohort of adult kidney transplant patients from January 1, 2007, through December 31, 2016, who required ICU admission after 30 days of transplantation. The admissions were divided into 3 groups based on their timeline between transplantation and ICU admission: 1. group 1 from 30 days to 6 months, 2. group 2 between 6-24 months, and 3. group 3 after 2 years. All admissions were categorized according to the primary organ system involved. RESULTS A total of 285 (group 1: 50, group 2: 89, group 3: 146) patients required 404 ICU admissions (group 1: 57, group 2: 108, group 3: 239). Overall, cardiovascular system-related admissions (29.9%, 18.5%, 15.9%), infections (19.3%, 25.9%, 27.2%), and respiratory-related admissions (12.3%, 8.3%, 8.8%) were main causes in all 3 groups. A total of 24 (8.4%) patients died in the ICU. Most of the deaths occurred in men (79.2%), infection-related admissions (45.8%), and individuals with a functioning allograft (66.7%). Infections (45.8%) were the main causes of ICU-related mortality. Median time from transplantation to death was 2.3 years (interquartile range: 1.2-4.6). CONCLUSION Kidney transplant patients continue to be at risk of requiring high acuity care long after transplantation. Most of these admissions are related to cardiopulmonary system involvement or infections. Overall, infections were the leading cause of ICU-related mortality.
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Affiliation(s)
- Nitin Abrol
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Mikel Prieto
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Timucin Taner
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
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Abrol N, Kashyap R, Kashani KB, Prieto M, Taner T. Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study. Mayo Clin Proc Innov Qual Outcomes 2020; 4:521-528. [PMID: 33083700 PMCID: PMC7557163 DOI: 10.1016/j.mayocpiqo.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To study the characteristics and outcomes of a cohort of kidney transplant recipients who required high-acuity care after transplant surgery. Patients and Methods All adult (aged ≥18 years) solitary kidney transplant recipients from January 1, 2007, through December 31, 2016, were screened and those who required high-acuity care within the same hospitalization were enrolled. Patient demographic and clinical data were collected from the departmental database and electronic DataMart. Results Of 1525 patients, 266 (17.4%) required high-acuity care after the kidney transplant operation: 166 (62.4%) directly from the operating room and 100 (37.6%) after an interval during the same hospitalization. Overall, 2 main indications were hypotension (n=87; 32.7%) and cardiac rhythm disturbances (n=83; 31.2%). Recipients in the direct admission group had higher medium body mass index (31.0 [interquartile range, 26.6-36.0] vs 28.0 [interquartile range, 24.3-32.4] kg/m2; P<.001) and were more likely to have undergone a concomitant procedure with the transplant surgery. Overall, in-hospital mortality was 1.9% (n=5). Conclusion In contemporary practice, patients with higher body mass index are more likely to require high-acuity care immediately after kidney transplant surgery. The most common reasons are hypotension and cardiac rhythm disorders. The overall intensive care unit mortality rate of these patients is low. However, these patients are at risk for graft loss and death in the long term compared with patients who do not require intensive care unit care after transplant surgery.
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Key Words
- ADPKD, autosomal dominant polycystic kidney disease
- APACHE, Acute Physiology and Chronic Health Evaluation
- ASA, American Society of Anesthesiologists
- BMI, body mass index
- ESRD, end-stage renal disease
- ICU, intensive care unit
- IMV, invasive mechanical ventilation
- IQR, interquartile range
- LOS, length of stay
- NIMV, noninvasive mechanical ventilation
- OR, operating room
- PACU, postanesthesia care unit
- SOFA, Sequential Organ Failure Assessment
- Tx, transplant
- WIT, warm ischemia time
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Affiliation(s)
- Nitin Abrol
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.,Department Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Mikel Prieto
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Abstract
PURPOSE OF REVIEW The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption. RECENT FINDINGS Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category. SUMMARY Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.
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Affiliation(s)
- Thomas Hughes
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hui Ching Ho
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shahrokh Francois Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
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Zeuschner P, Sester U, Stöckle M, Saar M, Zompolas I, El-Bandar N, Liefeldt L, Budde K, Öllinger R, Ritschl P, Schlomm T, Mihm J, Friedersdorff F. Should We Perform Old-for-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay. J Clin Med 2020; 9:jcm9061835. [PMID: 32545566 PMCID: PMC7356807 DOI: 10.3390/jcm9061835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Urban Sester
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Ilias Zompolas
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Lutz Liefeldt
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Paul Ritschl
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Janine Mihm
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
- Correspondence:
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Abrol N, Kashyap R, Frank RD, Iyer VN, Dean PG, Stegall MD, Prieto M, Kashani KB, Taner T. Preoperative Factors Predicting Admission to the Intensive Care Unit After Kidney Transplantation. Mayo Clin Proc Innov Qual Outcomes 2019; 3:285-293. [PMID: 31485566 PMCID: PMC6713836 DOI: 10.1016/j.mayocpiqo.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/30/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To identify preoperative factors predicting early admission (within 30 days) of adult kidney transplant recipients to the intensive care unit (ICU). PATIENTS AND METHODS This is a single-center retrospective study of consecutive kidney transplant recipients between January 1, 2007, and December 31, 2016. Children (aged <18 years) and patients who underwent simultaneous multiorgan transplantation were excluded from the analysis. Associations between demographic, transplant-related, and comorbidity variables with ICU admission within 30 days of transplantation were analyzed using univariate and multivariate logistic regression models. RESULTS Of the 1527 eligible patients, 305 (20%) required early ICU admission. In univariate analysis, older age, higher body mass index (BMI), previous transplantation, myocardial infarction, congestive heart failure, obstructive pulmonary disease, longer ischemia time, pretransplant dialysis, and transplantation from a deceased donor were associated with increased odds of ICU admission. After multivariate adjustment, every 10-year increase in recipient age (odds ratio [OR], 1.26; 95% CI, 1.12-1.42; P<.001), 5-unit increase in BMI (OR, 1.11; 95% CI, 1.00-1.22; P=.049), pretransplant dialysis (OR, 1.57; 95% CI, 1.19-2.08; P=.002), and deceased donor transplantation (OR, 1.82; 95% CI, 1.29-2.55; P<.001) were associated with the increased risk of ICU admission. Preemptive transplantation (OR, 0.64; 95% CI, 0.48-0.84; P=.002) and living donor kidney transplantation (OR, 0.55; 95% CI, 0.39-0.77; P<.001) were associated with lower odds of ICU admission after transplantation. CONCLUSION Recipient age, BMI, and the need for pretransplant dialysis are associated with a higher risk of early ICU admission after kidney transplantation, whereas living donor kidney transplantation and preemptive transplantation decrease these odds. Early referral of patients with end-stage renal disease for preemptive transplantation and living donor kidney transplantation can significantly reduce transplant-related ICU admissions.
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Key Words
- ASA, American Society of Anesthesiologists
- BMI, body mass index
- CHF, congestive heart failure
- COPD, chronic obstructive pulmonary disease
- DM, diabetes mellitus
- ESRD, end-stage renal disease
- ICU, intensive care unit
- ILD, interstitial lung disease
- IQR, interquartile range
- MI, myocardial ischemia
- OR, odds ratio
- PVD, peripheral vascular disease
- WIT, warm ischemia time
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Affiliation(s)
- Nitin Abrol
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ryan D. Frank
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Vivek N. Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Patrick G. Dean
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Mark D. Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Mikel Prieto
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Department Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Brunot V, Larcher R, Amalric M, Platon L, Tudesq JJ, Besnard N, Daubin D, Corne P, Jung B, Klouche K. Prise en charge du transplanté rénal en réanimation. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La transplantation rénale est la thérapeutique de choix de l’insuffisance rénale chronique au stade ultime, son usage est de plus en plus large. Les progrès réalisés dans les traitements immunosuppresseurs ont permis une amélioration de la durée de vie du greffon, mais au prix d’une augmentation des complications cardiovasculaires et infectieuses. Environ 5 % des transplantés rénaux présentent des complications sévères qui nécessitent une prise en charge intensive. Elles sont principalement de cause infectieuse et dominées par la défaillance respiratoire aiguë. L’insuffisance rénale aiguë est commune, elle affecte la fonction du greffon à court et long termes. La prise en charge en réanimation de ces complications doit prendre en compte le terrain particulier du transplanté rénal et les effets délétères de l’immunosuppression, condition nécessaire à une amélioration de la mortalité qui reste à plus de 30 %.
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