title: Kidney Transplant Recipients Requiring Critical Care Admission Within One Year of Transplant.
abstract: OBJECTIVE
  Kidney transplant is the gold standard for treatment of renal failure. With the increasing age of the recipient population, which carries significant comorbidities, and the use of more marginal organs, there is potential for increased critical care admissions. In this study, we investigated the incidence, indications, and outcomes of patients admitted to critical care within 1 year of transplant. We also aimed to identify any precipitating factors or events that may trigger these admissions, as well as establish variables that could affect mortality.
  
  
  METHODS
  We performed a retrospective analysis of kidney transplant recipients admitted to critical care within 1 year after transplant, between January 2009 and December 2013.
  
  
  RESULTS
  Of 1002 kidney transplants, 53 patients (5.3%) were admitted to critical care within 1 year, with patients separated into 2 groups. Group 1 comprised 32 patients (61%) who were admitted immediately postoperatively, mainly from cardiorespiratory derangements with mean stay of 3.7 days (range, 1-34 days) and 0 mortalities. Group 2 comprised 21 patients (39%) who were admitted later in the postoperative period, principally from sepsis-related complications with a mean stay of 18 days (range, 1-101 days). Most patients in group 2 required intensive therapy, including mechanical ventilation and immunosupprression reduction, incurring a hospital mortality rate of 48%. Hemorrhage with reexploration was higher in group 1. Diabetes mellitus, cardiac comorbidity, prolonged stay, nutritional support, nosocomial infections, and multiple organ failure were found at a higher rate in the group 2 patients who died.
  
  
  CONCLUSIONS
  The incidence of critical care admissions 1 year after kidney transplant was 5.3%. Most admissions occurred in the early postoperative period, mostly as preemptive measures for cardiorespiratory monitoring and support. This category of admission is potentially preventable with optimization of preoperative treatment. Later admissions were mostly consequential to sepsis-related complications, with patients having a high mortality rate due to multiple organ failure. Clinical management should therefore focus on the prevention of multiple organ failure to improve patient outcomes.
authors.affiliation: From the Department of Transplantation, Central Manchester University Hospitals, United Kingdom.
authors.forename: Okechukwu O
authors.initials: OO
authors.lastname: Okidi
authors.forename: David
authors.initials: D
authors.lastname: Van Dellen
authors.forename: Cassandra
authors.initials: C
authors.lastname: Sobajo
authors.forename: Angela
authors.initials: A
authors.lastname: Summers
authors.forename: John R
authors.initials: JR
authors.lastname: Greer
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult