Long-term renal function and survival of renal transplant recipients admitted to the intensive care unit

Arulkumaran N, West S, Chan K, Templeton M, Taube D, Brett SJ. Long‐term renal function and survival of renal transplant recipients admitted to the intensive care unit.
Clin Transplant 2012: 26: E24–E31.
© 2011 John Wiley & Sons A/S. Abstract: Introduction: We determined the long‐term mortality and renal allograft function of renal transplant recipients admitted to the intensive care unit (ICU). Methods: A single institution retrospective observational cohort study of all renal transplant patients admitted to the ICU was performed. Serum creatinine was recorded up to one yr after hospital discharge and survival data were collected for three yr. Results: Chest sepsis was the commonest reason for ICU admission. ICU and hospital mortality were 32% and 19% respectively. Predictors of hospital mortality included the presence of sepsis and duration of mechanical ventilation (MV). Of the patients who were discharged from ICU, three‐yr mortality was 50%. Renal function at one yr was worse than that at hospital discharge and at baseline, though not statistically significant. Death‐censored allograft loss was 11% over the three‐yr follow up period. Conclusions: Sepsis and requirement for MV are independent predictors of mortality in renal transplant recipients admitted to ICU. Renal transplant recipients with chest sepsis may warrant earlier ICU admission. Any loss of renal allograft function during an episode of critical illness appears to have a lasting effect, and longterm patient and allograft survival is poor.