title: The Critically Ill Kidney Transplant Recipient: A Narrative Review.
abstract: Kidney transplantation is the most common solid organ transplantation performed worldwide. Up to 6% of kidney transplant recipients experience a life-threatening complication that requires ICU admission, chiefly in the late posttransplantation period (≥ 6 months). Acute respiratory failure and septic shock are the main reasons for ICU admission. Cardiac pulmonary edema, bacterial pneumonia, acute graft pyelonephritis, and bloodstream infections account for the vast majority of diagnoses in the ICU. Pneumocystis jirovecii pneumonia is the most common opportunistic infection, and one-half of the patients so infected require mechanical ventilation. The incidence of cytomegalovirus visceral infections in the era of preemptive therapy has dramatically decreased. Drug-related neutropenia, sirolimus-related pneumonitis, and posterior reversible encephalopathy syndrome are among the most common immunosuppression-associated toxic effects. Importantly, the impact of critical illness on graft function is worrisome. Throughout the ICU stay, acute kidney injury is common, and about 40% of the recipients require renal replacement therapy. One-half of the patients are discharged alive and free from dialysis. Hospital mortality can reach 30% and correlates with acute illness severity and reason for ICU admission. Transplant characteristics are not predictors of short-term survival. Graft survival depends on pre-ICU graft function, disease severity, and renal toxicity of ICU investigations and treatments.
authors.affiliation: Medical Intensive Care Unit Department, Saint-Louis University Hospital, Paris, France. Electronic address: emmanuel.canet@aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.affiliation: Medical Intensive Care Unit Department, Saint-Louis University Hospital, Paris, France; Paris Diderot University, Sorbonne Paris Cité Paris, France.
authors.forename: Lara
authors.initials: L
authors.lastname: Zafrani
authors.affiliation: Medical Intensive Care Unit Department, Saint-Louis University Hospital, Paris, France; Paris Diderot University, Sorbonne Paris Cité Paris, France.
authors.forename: Élie
authors.initials: É
authors.lastname: Azoulay
mesh_terms: D016638:Critical Illness / Q000453:epidemiology; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D010346:Patient Care Management / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology
keywords: Pneumocystis jirovecii; critical care; renal transplants