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. 2019 Aug 23;3(3):285-293.
doi: 10.1016/j.mayocpiqo.2019.06.008. eCollection 2019 Sep.

Preoperative Factors Predicting Admission to the Intensive Care Unit After Kidney Transplantation

Nitin Abrol  1 , Rahul Kashyap  2 , Ryan D Frank  3 , Vivek N Iyer  4 , Patrick G Dean  1 , Mark D Stegall  1 , Mikel Prieto  1 , Kianoush B Kashani  4   5 , Timucin Taner  1
Affiliations

Preoperative Factors Predicting Admission to the Intensive Care Unit After Kidney Transplantation

Nitin Abrol et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To identify preoperative factors predicting early admission (within 30 days) of adult kidney transplant recipients to the intensive care unit (ICU).

Patients and methods: This is a single-center retrospective study of consecutive kidney transplant recipients between January 1, 2007, and December 31, 2016. Children (aged <18 years) and patients who underwent simultaneous multiorgan transplantation were excluded from the analysis. Associations between demographic, transplant-related, and comorbidity variables with ICU admission within 30 days of transplantation were analyzed using univariate and multivariate logistic regression models.

Results: Of the 1527 eligible patients, 305 (20%) required early ICU admission. In univariate analysis, older age, higher body mass index (BMI), previous transplantation, myocardial infarction, congestive heart failure, obstructive pulmonary disease, longer ischemia time, pretransplant dialysis, and transplantation from a deceased donor were associated with increased odds of ICU admission. After multivariate adjustment, every 10-year increase in recipient age (odds ratio [OR], 1.26; 95% CI, 1.12-1.42; P<.001), 5-unit increase in BMI (OR, 1.11; 95% CI, 1.00-1.22; P=.049), pretransplant dialysis (OR, 1.57; 95% CI, 1.19-2.08; P=.002), and deceased donor transplantation (OR, 1.82; 95% CI, 1.29-2.55; P<.001) were associated with the increased risk of ICU admission. Preemptive transplantation (OR, 0.64; 95% CI, 0.48-0.84; P=.002) and living donor kidney transplantation (OR, 0.55; 95% CI, 0.39-0.77; P<.001) were associated with lower odds of ICU admission after transplantation.

Conclusion: Recipient age, BMI, and the need for pretransplant dialysis are associated with a higher risk of early ICU admission after kidney transplantation, whereas living donor kidney transplantation and preemptive transplantation decrease these odds. Early referral of patients with end-stage renal disease for preemptive transplantation and living donor kidney transplantation can significantly reduce transplant-related ICU admissions.

Keywords: ASA, American Society of Anesthesiologists; BMI, body mass index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; ESRD, end-stage renal disease; ICU, intensive care unit; ILD, interstitial lung disease; IQR, interquartile range; MI, myocardial ischemia; OR, odds ratio; PVD, peripheral vascular disease; WIT, warm ischemia time.

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Figures

Figure
Figure
Flowchart showing the inclusion of study participants. ICU = intensive care unit.
See this image and copyright information in PMC

References

    1. Wolfe R.A., Ashby V.B., Milford E.L., et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–1730. - PubMed
    1. Tonelli M., Wiebe N., Knoll G., et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–2109. - PubMed
    1. Port F.K., Wolfe R.A., Mauger E.A., Berling D.P., Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993;270(11):1339–1343. - PubMed
    1. Schnuelle P., Lorenz D., Trede M., Van Der Woude F.J. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998;9(11):2135–2141. - PubMed
    1. Dripps R.D. New classification of physical status. Anesthesiology. 1963;24:111.

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