Bozkurt Yılmaz H Eylül, Küpeli Elif, Şen Nazan, Arer İlker, Çalışkan Kenan, Akçay Şule, Haberal Mehmet
From the Pulmonary Medicine, Baskent University, Adana, Turkey.
Exp Clin Transplant. 2019 Jan;17(Suppl 1):172-174. doi: 10.6002/ect.MESOT2018.P49.
We evaluated the frequency and cause of acute respiratory failure in renal transplant recipients.
Our single-center retrospective observational study included consecutive renal transplant recipients who were admitted to an intensive care unit for acute respiratory failure between 2011 and 2017. Acute respiratory failure was defined as oxygen saturation < 92% or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of noninvasive or invasive mechanical ventilation.
Of 187 renal transplant recipients, 35 (18.71%) required intensive care unit admission; 11 of these patients (31.4%) were admitted to the intensive care unit with acute respiratory failure. Six of these patients (54.5%) had pneumonia and had shown infiltrates on chest radiography, which were shown in a minimum of 3 zones of the lung (2 with Klebsiella pneumonia, 1 with Acinetobacter species, 1 with Proteus mirabilis, 2 with no microorganisms). The other reasons for acute respiratory failure were cardiogenic pulmonary edema (2 patients), acute respiratory distress syndrome (2 patients, due to acute pancreatitis and acute cerebrovascular thromboembolism), and exacerbation of chronic obstructive pulmonary disease (1 patient). Six patients (54.5%) needed invasive mechanical ventilation because of pneumonia (3 patients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Hemodialysis was administered in 5 patients (45%). Six of 11 patients died due to pneumonia (3 p atients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Among the 5 survivors, 3 (60%) had recovered previous graft function.
Acute respiratory failure is associated with high mortality and morbidity in renal transplant recipients. Main causes of acute respiratory failure were bacterial pneumonia and cardiogenic pulmonary edema in our study population. Extended chemoprophylaxis for bacterial and fungal infection and early intensive care unit admission of patients with acute respiratory failure may improve outcomes.
我们评估了肾移植受者急性呼吸衰竭的发生率及病因。
我们的单中心回顾性观察研究纳入了2011年至2017年间因急性呼吸衰竭入住重症监护病房的连续性肾移植受者。急性呼吸衰竭的定义为在室内空气中氧饱和度<92%或动脉血氧分压<60 mmHg和/或需要无创或有创机械通气。
187例肾移植受者中，35例（18.71%）需要入住重症监护病房；其中11例患者（31.4%）因急性呼吸衰竭入住重症监护病房。这些患者中有6例（54.5%）发生肺炎，胸部X线片显示有浸润影，至少累及肺部3个区域（2例为肺炎克雷伯菌肺炎，1例为不动杆菌属，1例为奇异变形杆菌，2例未检出微生物）。急性呼吸衰竭的其他原因有心源性肺水肿（2例患者）、急性呼吸窘迫综合征（2例患者，分别由急性胰腺炎和急性脑血管血栓栓塞引起）以及慢性阻塞性肺疾病加重（1例患者）。6例患者（54.5%）因肺炎（3例患者）、心源性肺水肿（2例患者）和脑血管血栓栓塞（1例患者）需要有创机械通气。5例患者（45%）接受了血液透析。11例患者中有6例死于肺炎（3例患者）、心源性肺水肿（2例患者）和脑血管血栓栓塞（1例患者）。在5名幸存者中，3例（60%）恢复了移植肾之前的功能。
急性呼吸衰竭在肾移植受者中与高死亡率和高发病率相关。在我们的研究人群中，急性呼吸衰竭的主要原因是细菌性肺炎和心源性肺水肿。对细菌和真菌感染进行延长化学预防以及对急性呼吸衰竭患者早期入住重症监护病房可能会改善预后。
