Survival of rehospitalized kidney allograft recipients

Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge. We reviewed the follow-up data [from the time of discharge after first rehospitalization] of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function [serum creatinine less than 1.6 mg/dL]. Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined. The mean duration of follow-up [from the time of discharge after the first rehospitalization] was 38.9 +/- 11.2 months [range, 6 to 84 months]. The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients [21.9%] experienced more hospitalization episodes [mean, 2.6 +/- 2.0 times], while 193 [78.1%] had no further hospitalizations during the follow-up period. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function

Additional burden of intensive care to rehospitalizations following kidney transplantation. A study of rate, causes, and risk factors

Little information exists on the burden of intensive care unit [ICU] to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission. A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed. Twenty-five rehospitalized kidney transplant recipients [4.3%] had been admitted to ICU with kidney dysfunction [36.0%], cerebrovascular accident [24.0%], sepsis [16.0%], brain tumor [8.0%], brain abscess [4.0%], diabetic ketoacidosis [4.0%], trauma [4.0%], and hemodynamic shock [4.0%]. The risk factors of referral to ICU were higher age [P = .001] and hospitalization for cerebrovascular accident [P = .001] and malignancy [P = .004]. Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively. Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients

Atherosclerosis after kidney transplantation Changes of intime-media thichness of carotids during early posttransplant period

The aim of this study was to evaluate atherosclerotic changes in the carotid artery following kidney transplantation. Twenty- sis nonsmoker kidney allograft recipients who did not have cardiovascular disease or diabetes mellitus were enrolled in the study. The carotid intima-media thickness [IMT] was measured at 12 points using the patient's IMT. We followed the patients and changes in the carotid IMT were evaluated every 2 months up to the 6 th posttransplant month. The mean age of the patients at transplantation was 41.5 +/- 11.1 years. The mean baseline IMT was 0.84 +/- 0.22 mm. During the follow-up period it reached 0.85 +/- 0.22mm, 0.87 +/- 0.23 mm [P=0.1], and 0.88 +/- 0.24 mm /[P=.002] after 2, 4, and 6 months, respectively. The IMT measures significantly correlated stroke and 0.82 mm for MI, we found that 57.7% and 68% of the patients were at the risk of stroke at baseline and 6 months after transplantation [P<.001]. Also, 46.2% of the patients were at the risk of MI at baseline that rose to 53.8% at the end of the study [P<.001]. Atherosclerosis is an early event after kidney transplantation even in asymptomatic patients and those without major risk factors such as cardiovascular disease, diabetes mellitus, and smoking. Early diagnosis and treatment of atherosclerosis is of utmost importance