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.