Abrol Nitin, Kashyap Rahul, Kashani Kianoush B, Prieto Mikel, Taner Timucin
William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 19;4(5):521-528. doi: 10.1016/j.mayocpiqo.2020.05.010. eCollection 2020 Oct.
To study the characteristics and outcomes of a cohort of kidney transplant recipients who required high-acuity care after transplant surgery.
All adult (aged ≥18 years) solitary kidney transplant recipients from January 1, 2007, through December 31, 2016, were screened and those who required high-acuity care within the same hospitalization were enrolled. Patient demographic and clinical data were collected from the departmental database and electronic DataMart.
Of 1525 patients, 266 (17.4%) required high-acuity care after the kidney transplant operation: 166 (62.4%) directly from the operating room and 100 (37.6%) after an interval during the same hospitalization. Overall, 2 main indications were hypotension (n=87; 32.7%) and cardiac rhythm disturbances (n=83; 31.2%). Recipients in the direct admission group had higher medium body mass index (31.0 [interquartile range, 26.6-36.0] vs 28.0 [interquartile range, 24.3-32.4] kg/m; <.001) and were more likely to have undergone a concomitant procedure with the transplant surgery. Overall, in-hospital mortality was 1.9% (n=5).
In contemporary practice, patients with higher body mass index are more likely to require high-acuity care immediately after kidney transplant surgery. The most common reasons are hypotension and cardiac rhythm disorders. The overall intensive care unit mortality rate of these patients is low. However, these patients are at risk for graft loss and death in the long term compared with patients who do not require intensive care unit care after transplant surgery.
研究一组肾移植受者在移植手术后需要高 acuity 护理的特征及结局。
对 2007 年 1 月 1 日至 2016 年 12 月 31 日期间所有成年（年龄≥18 岁）单肾移植受者进行筛查，纳入在同一住院期间需要高 acuity 护理的患者。从科室数据库和电子数据集市收集患者人口统计学和临床数据。
1525 例患者中，266 例（17.4%）在肾移植手术后需要高 acuity 护理：166 例（62.4%）直接从手术室转入，100 例（37.6%）在同一住院期间经过一段时间后转入。总体而言，2 个主要指征为低血压（n = 87；32.7%）和心律失常（n = 83；31.2%）。直接入院组受者的平均体重指数较高（31.0[四分位间距，26.6 - 36.0] vs 28.0[四分位间距，24.3 - 32.4]kg/m²；P <.001），并且更有可能在移植手术时同时进行了其他手术。总体而言，住院死亡率为 1.9%（n = 5）。
在当代实践中，体重指数较高的患者在肾移植手术后更有可能立即需要高 acuity 护理。最常见的原因是低血压和心律失常。这些患者的总体重症监护病房死亡率较低。然而，与移植手术后不需要重症监护病房护理的患者相比，这些患者长期存在移植肾丢失和死亡的风险。
