Acute respiratory failure in kidney transplant recipients: a multicenter study.

Emmanuel Canet (1) , David Osman , Jérome Lambert (1) , Christophe Guitton (2) , Anne-Elisabeth Heng , Laurent Argaud (3) , Kada Klouche (4) , Georges Mourad (5) , Christophe Legendre (6) , Jean-François Timsit (7) , Eric Rondeau , Maryvonne Hourmant (8) , Antoine Durrbach (9) , Denis Glotz (10) , Bertrand Souweine (11) , Benoît Schlemmer (12) , Elie Azoulay (13)

1 Medical Intensive Care Unit and Biostatistics Departments
2 Service de Réanimation Médicale
3 LBFA - Laboratoire de bioénergétique fondamentale et appliquée
4 Département d'anesthésie-réanimation[Montpellier]
5 Service de Pédiatrie spécialisée
6 Service de néphrologie adultes [CHU Necker]
7 INSERM U823 - Institut d'oncologie/développement Albert Bonniot de Grenoble
8 ITUN - Institut de transplantation urologie-néphrologie
9 Service de néphrologie
10 Service de Néphrologie [Saint-Louis]
11 LMGE - Laboratoire Microorganismes : Génome et Environnement
12 Service de réanimation médicale
13 Medical ICU

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.

Domaines: Médecine humaine et pathologie

Emmanuel Canet, David Osman, Jérome Lambert, Christophe Guitton, Anne-Elisabeth Heng, et al.. Acute respiratory failure in kidney transplant recipients: a multicenter study.. Critical Care, 2011, 15 (2), pp.R91. ⟨10.1186/cc10091⟩. ⟨hal-00841211⟩