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Guinault D, Del Bello A, Lavayssiere L, Nogier MB, Cointault O, Congy N, Esposito L, Hebral AL, Roques O, Kamar N, Faguer S. Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients. BMC Anesthesiol 2019; 19:130. [PMID: 31315561 PMCID: PMC6637509 DOI: 10.1186/s12871-019-0800-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023] Open
Abstract
Background Risk of over-immunosuppression or immunization may mitigate the overall and long-term renal outcomes of kidney transplant recipients (KTR) admitted to the ICU in the modern era but remain poorly described. Thus, there is an unmet need to better characterize the survival of KTR admitted to the ICU, but also the renal and immunological outcomes of survivors. Methods Retrospective observational study that included 200 KTR admitted between 2010 and 2016 to the ICU of a teaching hospital (median age 61 years [IQR 50.7–68]; time from transplantation 41 months [IQR 5–119]). Survival curves were compared using the Log-rank test. Results Mortality rates following admission to the ICU was low (26.5% at month-6), mainly related to early mortality (20% in-hospital), and predicted by the severity of the acute condition (SAPS2 score) but also by Epstein Barr Virus proliferation in the weeks preceding the admission to the ICU. Acute kidney injury (AKI) was highly prevalent (85.1%). Progression toward chronic kidney disease (CKD) was observed in 45.1% of survivors. 15.1% of survivors developed new anti-HLA antibodies (donor-specific antibodies 9.2% of cases) that may impact the long-term renal transplantation function. Conclusions Notwithstanding the potential biases related to the retrospective and monocentric nature of this study, our findings obtained in a large cohort of KTR suggest that survival of KTR admitted in ICU is good but in-ICU management of these patients may alter both survival and AKI to CKD transition, as well as HLA immunization. Further interventional studies, including systematic characterization of the Epstein Barr virus proliferation at the admission (i.e., a potential surrogate marker of an underlying immune paralysis and frailty) will need to address the optimal management of immunosuppressive regimen in ICU to improve survival but also renal and immunological outcomes.
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Affiliation(s)
- Damien Guinault
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Laurence Lavayssiere
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Marie-Béatrice Nogier
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Olivier Cointault
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Nicolas Congy
- Laboratoire d'Immunologie, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, F-31000, Toulouse, France
| | - Laure Esposito
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Anne-Laure Hebral
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Olivier Roques
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France.,Université Paul Sabatier, Toulouse III, F-31000, Toulouse, France.,Institut National de la Santé et de la Recherche Médicale, U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes, Unité de Réanimation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 1, avenue Jean Poulhes, 31059, Toulouse, France. .,Université Paul Sabatier, Toulouse III, F-31000, Toulouse, France. .,Institut National de la Santé et de la Recherche Médicale, Institut des Maladies Métaboliques et Cardiovasculaires, U1048 (Renal Fibrosis lab), and French Intensive care Renal Network (F.I.R.N), Toulouse, France.
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Azoulay E, Mokart D, Kouatchet A, Demoule A, Lemiale V. Acute respiratory failure in immunocompromised adults. THE LANCET. RESPIRATORY MEDICINE 2019; 7:173-186. [PMID: 30529232 PMCID: PMC7185453 DOI: 10.1016/s2213-2600(18)30345-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undetermined cause, a standardised diagnostic investigation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.
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Affiliation(s)
- Elie Azoulay
- Assistance Publique Hôpitaux de Paris, Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Paris, France; ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut national de la santé et de la recherche médicale, Paris Diderot Sorbonne University, Paris, France.
| | - Djamel Mokart
- Medical Surgical Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Centre hospitalier universitaire d'Angers, Angers, France
| | - Alexandre Demoule
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Institut national de la santé et de la recherche médicale, Sorbonne Universités, Paris, France
| | - Virginie Lemiale
- Assistance Publique Hôpitaux de Paris, Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Paris, France; ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut national de la santé et de la recherche médicale, Paris Diderot Sorbonne University, Paris, France
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Takahashi K, Go P, Stone CH, Safwan M, Putchakayala KG, Kane WJ, Malinzak LE, Kim DY, Denny JE. Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:399-404. [PMID: 28408734 PMCID: PMC5398249 DOI: 10.12659/ajcr.902380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 50 Final Diagnosis: Pulmonary fibrosis Symptoms: Short of breath Medication: — Clinical Procedure: — Specialty: Transplantology
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Affiliation(s)
- Kazuhiro Takahashi
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Pauline Go
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Chad H Stone
- Department of Pathology, Henry Ford Hospital, Detroit, MI, USA
| | - Mohamed Safwan
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Krishna G Putchakayala
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - William J Kane
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Lauren E Malinzak
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Dean Y Kim
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Jason E Denny
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
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