Risk factors for septic complications in kidney transplant recipients.
BACKGROUND
Septic complications following kidney transplantation are a leading cause of therapeutic failure. An early diagnosis may protect the recipient from the severe consequences of sepsis. We sought to determine the risk factors influencing the occurrence of septic complications among kidney transplant recipients.


METHODS
The 146 potential donors included in the study were evaluated for brain stem death criteria. Supportive management included mechanical ventilation to normocapnia, rewarming, as well as fluid and electrolyte replacement. Dopamine infusions and desaminovasopressin were titrated to predetermined mean arterial pressure (MAP). Central venous pressure (CVP) was maintained at 8 to 11 mm Hg. Hemodynamic data were acquired by the thermodilution method prior to organ procurement: MAP, CVP, pulmonary capillary wedge pressure (PCWP), and systemic vascular resistance index (SVRI). Recipient data included age, gender, period of prior hemodialysis, panel reactive antibodies, cold ischemia time, and cause of renal insufficiency. The 232 kidney recipients were examined for occurrence of septic complications including septicemia, pneumonia, peritonitis, or graft infection.


RESULTS
Kidney transplants from donors with MAP < 70 mm Hg and SVRI < 1200 dyne x s/cm(5) x m(2) showed a significantly higher occurrence of septic complications in recipients (P < .05) where mortality rate was also significantly greater (P < .01).


CONCLUSIONS
MAP < 70 mm Hg and SVRI < 1200 dyne x s/cm(5) x m(2) among organ donors predicted greater occurrence of septic complications and increased mortality among kidney transplant recipients.
Clinic of Anaesthesiology and Intensive Care, Department of Anaesthesiology and Intensive Therapy, PomeranianMedical University, ul Powstańców Wlkp 72, 70-111 Szczecin, Poland. zukowski@sci.pam.szczecin.pl
M
M
Zukowski
R
R
Bohatyrewicz
J
J
Biernawska
K
K
Kotfis
M
M
Zegan
R
R
Knap
M
M
Janeczek
Z
Z
Zietek
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001926:Brain Death; D002102:Cadaver; D002423:Cause of Death; D002496:Central Venous Pressure / Q000502:physiology; D002648:Child; D005260:Female; D006339:Heart Rate; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D012772:Shock, Septic / Q000453:epidemiology; D014019:Tissue Donors; D014655:Vascular Resistance; D055815:Young Adult