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Critical Care
Published in: Critical Care 2/2011

Open Access 01-04-2011 | Research

Acute respiratory failure in kidney transplant recipients: a multicenter study

Authors: Emmanuel Canet, David Osman, Jérome Lambert, Christophe Guitton, Anne-Elisabeth Heng, Laurent Argaud, Kada Klouche, Georges Mourad, Christophe Legendre, Jean-François Timsit, Eric Rondeau, Maryvonne Hourmant, Antoine Durrbach, Denis Glotz, Bertrand Souweine, Benoît Schlemmer, Elie Azoulay

Published in: Critical Care | Issue 2/2011

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Abstract

Introduction

Data on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients.

Methods

We conducted a retrospective observational study in nine transplant centers of consecutive kidney transplant recipients admitted to the intensive care unit (ICU) for ARF from 2000 to 2008.

Results

Of 6,819 kidney transplant recipients, 452 (6.6%) required ICU admission, including 200 admitted for ARF. Fifteen (7.5%) of these patients had combined kidney-pancreas transplantations. The most common causes of ARF were bacterial pneumonia (35.5%), cardiogenic pulmonary edema (24.5%) and extrapulmonary acute respiratory distress syndrome (ARDS) (15.5%). Pneumocystis pneumonia occurred in 11.5% of patients. Mechanical ventilation was used in 93 patients (46.5%), vasopressors were used in 82 patients (41%) and dialysis was administered in 104 patients (52%). Both the in-hospital and 90-day mortality rates were 22.5%. Among the 155 day 90 survivors, 115 patients (74.2%) were dialysis-free, including 75 patients (65.2%) who recovered prior renal function. Factors independently associated with in-hospital mortality were shock at admission (odds ratio (OR) 8.70, 95% confidence interval (95% CI) 3.25 to 23.29), opportunistic fungal infection (OR 7.08, 95% CI 2.32 to 21.60) and bacterial infection (OR 2.53, 95% CI 1.07 to 5.96). Five factors were independently associated with day 90 dialysis-free survival: renal Sequential Organ Failure Assessment (SOFA) score on day 1 (OR 0.68/SOFA point, 95% CI 0.52 to 0.88), bacterial infection (OR 0.43, 95% CI 0.21 to 0.90), three or four quadrants involved on chest X-ray (OR 0.44, 95% CI 0.21 to 0.91), time from hospital to ICU admission (OR 0.98/day, 95% CI 0.95 to 0.99) and oxygen flow at admission (OR 0.93/liter, 95% CI 0.86 to 0.99).

Conclusions

In kidney transplant recipients, ARF is associated with high mortality and graft loss rates. Increased Pneumocystis and bacterial prophylaxis might improve these outcomes. Early ICU admission might prevent graft loss.
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Literature
1.
Sayegh MH, Carpenter CB: Transplantation 50 years later: progress, challenges, and promises. N Engl J Med 2004, 351: 2761-2766. 10.1056/NEJMon043418CrossRefPubMed
2.
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999, 341: 1725-1730. 10.1056/NEJM199912023412303CrossRefPubMed
3.
Kamar N, Garrigue V, Karras A, Mourad G, Lefrançois N, Charpentier B, Legendre C, Rostaing L: Impact of early or delayed cyclosporine on delayed graft function in renal transplant recipients: a randomized, multicenter study. Am J Transplant 2006, 6: 1042-1048. 10.1111/j.1600-6143.2006.01291.xCrossRefPubMed
4.
Mourad G, Karras A, Kamar N, Garrigue V, Legendre C, Lefrançois N, Charpentier B, Bourbigot B, Pouteil-Nobil C, Bayle F, Lebranchu Y, Mariat C, Le Meur Y, Kessler M, Moulin B, Ducloux D, Delahousse M, Lang P, Merville P, Chaouche-Teyara K, Rostaing L, French Myriade FR01 Study Group: Renal function with delayed or immediate cyclosporine microemulsion in combination with enteric-coated mycophenolate sodium and steroids: results of follow up to 30 months post-transplant. Clin Transplant 2007, 21: 295-300. 10.1111/j.1399-0012.2007.00660.xCrossRefPubMed
5.
Anglicheau D, Legendre C, Thervet E: Pharmacogenetics of tacrolimus and sirolimus in renal transplant patients: from retrospective analyses to prospective studies. Transplant Proc 2007, 39: 2142-2144. 10.1016/j.transproceed.2007.06.018CrossRefPubMed
6.
Moore J, Middleton L, Cockwell P, Adu D, Ball S, Little MA, Ready A, Wheatley K, Borrows R: Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis. Transplantation 2009, 87: 591-605. 10.1097/TP.0b013e318195a421CrossRefPubMed
7.
Webster A, Pankhurst T, Rinaldi F, Chapman JR, Craig JC: Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients. Cochrane Database Syst Rev 2006, 2: CD004756.PubMed
8.
Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D: Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000, 342: 605-612. 10.1056/NEJM200003023420901CrossRefPubMed
9.
Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK: Long-term survival in renal transplant recipients with graft function. Kidney Int 2000, 57: 307-313. 10.1046/j.1523-1755.2000.00816.xCrossRefPubMed
10.
Andrés A, Budde K, Clavien PA, Becker T, Kessler M, Pisarski P, Fornara P, Burmeister D, Hené RJ, Cassuto-Viguier E, SENIOR Study Team: A randomized trial comparing renal function in older kidney transplant patients following delayed versus immediate tacrolimus administration. Transplantation 2009, 88: 1101-1108.CrossRefPubMed
11.
Bayat S, Kessler M, Briançon S, Frimat L: Survival of transplanted and dialysed patients in a French region with focus on outcomes in the elderly. Nephrol Dial Transplant 2010, 25: 292-300. 10.1093/ndt/gfp469CrossRefPubMed
12.
Martín Navarro J, Ortega M, Gutiérrez MJ, García Martín F, Alcázar JM, Andrés A, Praga M: Survival of patients older than 60 years with kidneys transplanted from Spanish expanded criteria donors versus patients continued on hemodialysis. Transplant Proc 2009, 41: 2376-2378.CrossRefPubMed
13.
Gavela E, Pallárdo LM, Avila A, Sancho A, Beltrán S, Kanter J, Crespo JF: Renal allografts from donors older than 70 years are useful for single transplantation. Transplant Proc 2009, 41: 2047-2049. 10.1016/j.transproceed.2009.05.024CrossRefPubMed
14.
Moers C, Kornmann NS, Leuvenink HG, Ploeg RJ: The influence of deceased donor age and old-for-old allocation on kidney transplant outcome. Transplantation 2009, 88: 542-552. 10.1097/TP.0b013e3181b0fa8bCrossRefPubMed
15.
16.
Fishman JA: Infection in solid-organ transplant recipients. N Engl J Med 2007, 357: 2601-2614. 10.1056/NEJMra064928CrossRefPubMed
17.
Jamali FR, Otrock ZK, Soweid AM, Al-Awar GN, Mahfouz RA, Haidar GR, Bazarbachi A: An overview of the pathogenesis and natural history of post-transplant T-cell lymphoma. Leuk Lymphoma 2007, 48: 1780-1784. 10.1080/10428190701608657CrossRefPubMed
18.
Dantal J, Pohanka E: Malignancies in renal transplantation: an unmet medical need. Nephrol Dial Transplant 2007,22(Suppl 1):i4-i10. 10.1093/ndt/gfm085CrossRefPubMed
19.
Kahan BD: Fifteen years of clinical studies and clinical practice in renal transplantation: reviewing outcomes with de novo use of sirolimus in combination with cyclosporine. Transplant Proc 2008,40(10 Suppl):S17-S20. 10.1016/j.transproceed.2008.10.019CrossRefPubMed
20.
Fishman JA, Rubin RH: Infection in organ-transplant recipients. N Engl J Med 1998, 338: 1741-1751. 10.1056/NEJM199806113382407CrossRefPubMed
21.
Klouche K, Amigues L, Massanet P, Garrigue V, Delmas S, Szwarc I, Beraud JJ, Mourad G: Outcome of renal transplant recipients admitted to an intensive care unit: a 10-year cohort study. Transplantation 2009, 87: 889-895. 10.1097/TP.0b013e31819a688aCrossRefPubMed
22.
Candan S, Pirat A, Varol G, Torgay A, Zeyneloglu P, Arslan G: Respiratory problems in renal transplant recipients admitted to intensive care during long-term follow-up. Transplant Proc 2006, 38: 1354-1356. 10.1016/j.transproceed.2006.02.083CrossRefPubMed
23.
Shorr AF, Abbott KC, Agadoa LY: Acute respiratory distress syndrome after kidney transplantation: epidemiology, risk factors, and outcomes. Crit Care Med 2003, 31: 1325-1330. 10.1097/01.CCM.0000053645.38356.A6CrossRefPubMed
24.
Sharifipour F, Rezaeetalab F, Naghibi M: Pulmonary fungal infections in kidney transplant recipients: an 8-year study. Transplant Proc 2009, 41: 1654-1656. 10.1016/j.transproceed.2009.02.072CrossRefPubMed
25.
Radisic M, Lattes R, Chapman JF, del Carmen Rial M, Guardia O, Seu F, Gutierrez P, Goldberg J, Casadei DH: Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl Infect Dis 2003, 5: 84-93. 10.1034/j.1399-3062.2003.00018.xCrossRefPubMed
26.
Kaplan B, Meier-Kriesche HU: Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant 2002, 2: 970-974. 10.1034/j.1600-6143.2002.21015.xCrossRefPubMed
27.
Azoulay E, Mokart D, Lambert J, Lemiale V, Rabbat A, Kouatchet A, Vincent F, Gruson D, Bruneel F, Epinette-Branche G, Lafabrie A, Hamidfar-Roy R, Cracco C, Renard B, Tonnelier JM, Blot F, Chevret S, Schlemmer B: Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010, 182: 1038-1046. 10.1164/rccm.201001-0018OCCrossRefPubMed
28.
Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A, Bruneel F, Vincent F, Hamidfar R, Moreau D, Mohammedi I, Epinette G, Beduneau G, Castelain V, de Lassence A, Gruson D, Lemiale V, Renard B, Chevret S, Schlemmer B: Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med 2008, 36: 100-107. 10.1097/01.CCM.0000295590.33145.C4CrossRefPubMed
29.
Azoulay E, Parrot A, Flahault A, Cesari D, Lecomte I, Roux P, Saidi F, Fartoukh M, Bernaudin JF, Cadranel J, Mayaud C: AIDS-related Pneumocystis carinii pneumonia in the era of adjunctive steroids: implication of BAL neutrophilia. Am J Respir Crit Care Med 1999, 160: 493-499.CrossRefPubMed
30.
Rubin DB, Schenker N: Multiple imputation in health-care databases: an overview and some applications. Stat Med 1991, 10: 585-598. 10.1002/sim.4780100410CrossRefPubMed
31.
Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S: A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 1997, 16: 965-980. 10.1002/(SICI)1097-0258(19970515)16:9<965::AID-SIM509>3.0.CO;2-OCrossRefPubMed
32.
Harrell FE Jr, Lee KL, Mark DB: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996, 15: 361-387. 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4CrossRefPubMed
33.
34.
Kirilov D, Cohen J, Shapiro M, Grozovski E, Singer P: The course and outcome of renal transplant recipients admitted to a general intensive care unit. Transplant Proc 2003, 35: 606. 10.1016/S0041-1345(03)00007-1CrossRefPubMed
35.
Kogan A, Singer P, Cohen J, Grozovski E, Grunberg G, Mor E, Shapira Z: Readmission to an intensive care unit following liver and kidney transplantation: a 50-month study. Transplant Proc 1999, 31: 1892-1893. 10.1016/S0041-1345(99)00142-6CrossRefPubMed
36.
Aldawood A: The course and outcome of renal transplant recipients admitted to the intensive care unit at a tertiary hospital in Saudi Arabia. Saudi J Kidney Dis Transpl 2007, 18: 536-540.PubMed
37.
Green H, Paul M, Vidal L, Leibovici L: Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev 2007, 3: CD005590.PubMed
38.
De Castro N, Xu F, Porcher R, Pavie J, Molina JM, Peraldi MN: Pneumocystis jirovecii pneumonia in renal transplant recipients occurring after prophylaxis discontinuation: a case control-study. Clin Microbiol Infect 2009, in press.
39.
EBPG Expert Group on Renal Transplantation: European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia. Nephrol Dial Transplant 2002,17(Suppl 4):36-39.
40.
Sadaghdar H, Chelluri L, Bowles SA, Shapiro R: Outcome of renal transplant recipients in the ICU. Chest 1995, 107: 1402-1405. 10.1378/chest.107.5.1402CrossRefPubMed
41.
Tolkoff-Rubin NE, Rubin RH: Opportunistic fungal and bacterial infection in the renal transplant recipient. J Am Soc Nephrol 1992,2(12 Suppl):S264-S269.PubMed
42.
Azoulay E, Thiéry G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B: The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 2004, 83: 360-370. 10.1097/01.md.0000145370.63676.fbCrossRef
43.
Barbier F, Coquet I, Legriel S, Pavie J, Darmon M, Mayaux J, Molina JM, Schlemmer B, Azoulay E: Etiologies and outcome of acute respiratory failure in HIV-infected patients. Intensive Care Med 2009, 35: 1678-1686. 10.1007/s00134-009-1559-4CrossRefPubMed
Metadata
Title
Acute respiratory failure in kidney transplant recipients: a multicenter study
Authors
Emmanuel Canet
David Osman
Jérome Lambert
Christophe Guitton
Anne-Elisabeth Heng
Laurent Argaud
Kada Klouche
Georges Mourad
Christophe Legendre
Jean-François Timsit
Eric Rondeau
Maryvonne Hourmant
Antoine Durrbach
Denis Glotz
Bertrand Souweine
Benoît Schlemmer
Elie Azoulay
Publication date
01-04-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10091

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