Outcome of renal transplant recipients in the ICU.

OBJECTIVE: To determine the outcome of renal transplant recipients in an intensive care unit (ICU). DESIGN: Prospective, cohort study. SETTING: Surgical ICU in a tertiary care hospital. PATIENTS: Consecutive adult renal transplant recipients admitted to an ICU. MEASUREMENTS AND MAIN RESULTS: Demographic data, underlying diseases, indications for admission to the ICU, number of prior kidney transplantations, duration of immunosuppression, duration of mechanical ventilation, length of stay in ICU and hospital, and ICU and hospital mortality were recorded. Seventy-one patients were included in the study. Twenty-seven patients were admitted to the surgical ICU immediately after renal transplantation surgery for postoperative monitoring (group 1). One patient died in this group. The remaining 44 patients were renal transplant recipients admitted to the surgical ICU with various complications (group 2). The mean posttransplant time in group 2 was 23 +/- 30 months. Seven patients died in group 2. The overall ICU mortality in this study was 11% and hospital mortality was 14%. The hospital mortality for postoperative patients (3.7% in group 1) was below the rate predicted based on the acute physiology and chronic health evaluation (APACHE II) score (15%). APACHE II score, duration of mechanical ventilation, and ICU length of stay were significantly higher among nonsurvivors. The ICU mortality among renal transplant recipients was higher than that of other patients (6%) admitted to the surgical ICU during the study period. CONCLUSION: The ICU mortality of renal transplant recipients was twice that of general surgical ICU patients. The hospital mortality rate for recipients admitted immediately postoperatively to the ICU (group 1) was less than predicted by APACHE II.

Correlation of bronchoalveolar lavage findings to severity of Pneumocystis carinii pneumonia in AIDS. Evidence for the development of high-permeability pulmonary edema.

We correlated bronchoalveolar lavage findings with the clinical course and outcome of Pneumocystis pneumonia. Forty-eight patients with AIDS and a confirmed diagnosis of P carinii pneumonia were studied. Patients with additional pulmonary infections were excluded. On the basis of BAL findings, they were divided into those with a low neutrophil count (less than 5 percent) and those with a high neutrophil count (greater than or equal to 5 percent). Sixteen patients with AIDS but without PCP served as a control group. All BAL fluid samples from the control group showed a low neutrophil count. The group with PCP and a high neutrophil count had more severe respiratory compromise and greater morbidity than the group with PCP and a low neutrophil count. Mortality rate was not different. The group showing a high BALF neutrophil count also showed a higher BALF protein concentration, a higher ratio of BALF protein concentration to plasma protein concentration, and the presence of alpha 2-globulins compared with other groups. These findings suggest that increased alveolar-capillary permeability occurs during severe PCP.

Pulmonary Kaposi's sarcoma presenting as fulminant respiratory failure.

A 32-year-old black man, a homosexual patient with a history of lymphadenopathy, presented with diarrhea, weight loss, and a bilateral interstitial infiltrate. Within days after admission, the patient developed dyspnea with rapid progression to respiratory failure and a rapid increase of the infiltrate. An open-lung biopsy showed Kaposi's sarcoma. Treatment with chemotherapy reversed the respiratory failure.