Course and outcome of renal transplant recipients admitted to the intensive care unit: a 20-year study.

BACKGROUND: Renal transplantation represents the main treatment for end-stage renal disease. The goal of this study was to evaluate the course and outcome of renal transplant recipients admitted to the intensive care unit (ICU) and to analyze factors determining prognosis and mortality. METHODS: The demographic features, data admission characteristics, and ICU courses of all renal transplant recipients admitted to our ICU from 1992 to 2012 were evaluated to analyze factors for mortality. RESULTS: Eleven women and 50 men of mean age 45.5 ± 12.5 years were included in the study. Acute Physiology And Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores on ICU admission were 20 ± 5.7 and 8.5 ± 3.5, respectively. The main reasons for admission were as follows: sepsis (n = 27) or immediate postoperative complications (n = 16). Thirty-five patients during their ICU stay required hemodialysis and 34 needed catecholamines. The mortality rate was 42.6%. APACHE II Score, dialysis requirement, and sepsis as a reason for ICU admission were independently related to the mortality. CONCLUSIONS: The mortality rate was higher than that of the general ICU population (42.6% vs 30%). The main reason for ICU admission of renal transplant recipients was sepsis.

Acute kidney injury after orthotopic liver transplantation.

Acute kidney injury (AKI), one of the most frequent complications in the early period after liver transplantation, causes serious obstacles in the management of these patients affecting their outcomes. We studied retrospectively 79 subjects who underwent orthotopic liver transplantation (OLT). AKI was defined as an elevation of serum creatinine 1.5 times above baseline or an absolute serum creatinine level > 2 mg/dL. Our aim was to analyze the incidence, correlation with prior renal impairment, outcomes of AKI after OLT. Twenty-two patients (29.3%) developed AKI after OLT with 31.81% of the requiring renal replacement therapy. Among patients with AKI the duration of mechanical ventilation was prolonged (P = .001), length of stay in the intensive care unit was greater (P = .001), infections were more common (P = .016), and 30-day and 1-year mortality rates higher (P = .018). Logistic regression analysis showed post-OLT AKI to be an independent risk factor for 1-year mortality after OLT.

Infections after orthotopic liver transplantation in the intensive care unit.

PURPOSE: The purpose of the study was to assess the characteristics and risk factors of infections in the early period after orthopic liver transplantation (OLT) among adult patients. MATERIAL AND METHODS: We studied 75 patients who underwent OLT over 3 years from 2008 to 2010. We recorded all infections that developed during hospitalization in the intensive care unit (ICU) their outcomes, and the possible risk factors. RESULTS: During the study period in 80 OLT we recorded 19 bloodstream infections (47.5%), 7 ventilator-associated pneumonias (VAP; 17.5%), and 14 intra-abdominal infections (35%). Among the 40 isolated microbes, 72.5% were Gram negative, 25% were Gram positive, and 2.5% were fungi. The median time to developing the infection was 4.95 days (range 2-10). Patients with infections showed longer durations of mechanical ventilation, longer lengths of ICU stay, and lower 1-year survivals.