Solid organ transplant recipients with pneumonia in intensive care unit: A single center study
Fatma Irem Yesiler1, Cagla Yazar1, Helin Sahinturk1, Pinar Zeyneloglu1, Mehmet Haberal2.
1Anaesthesia, Baskent University, Ankara, Turkey; 2Transplantation, Baskent University, Ankara, Turkey
Introduction: Pneumonia is a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Occurrence of post-transplant pneumonia adversely impacts graft and recipient survival and the cost of care for SOT recipients. The aim of this study was to determine the demographic characteristics and outcomes of SOT recipients with pneumonia followed in ICU.
Methods: SOT recipients with pneumonia followed in ICU at our center between January 2016 and January 2019 were analyzed retrospectively using digital patient records. The data collected included Acute Physiology and Chronic Health Evaluation System (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Score (GCS), transplant type, immunosuppressive drugs, microbiologic findings, need for mechanical ventilation and tracheotomy, length of hospital, ICU stay and mortality.
Results: Out of 51 SOT recipients, 42 (82.4 %) were male and 9 (17.6%) were female. The mean age was 45.4 ± 16.6 years. Twenty six patients (51%) underwent kidney, 14 patients (27.5%) liver, 7 patients (13.7%) heart transplantation and 4 patients underwent combined kidney and liver transplantation. There were 28 patients who had more than 2 episodes. Most of the pneumonia episodes occurred 6 months after transplantation (70.6 %). The mean APACHE II score was 18.9 ± 7.7, GCS score was 12.5 ± 3.5, and SOFA score was 8.5 ± 3.9 at ICU admission. Among pneumonia cases 37.3 % were nosocomial, 33.3 % were community acquired. The microbiologic diagnostic method was tracheal aspirate in 52.9% and bonchoalveolar lavage in 21.6% of patients. The main pneumonia etiologies were bacterial (52.9%, n: 27), viral (23.5%, n: 12) and fungal infections (25.5%, n: 13). The most common immunsupressive agents were combined prednisolone, mycophenolate mofetil and tacrolimus (54.9%). Thirty three (64.7%) patients were intubated and received invasive mechanical ventilation, 16 patients (31.4%) required tracheotomy. The mean duration of ICU and hospital stay after pneumonia was 26.4 ± 74.7 and 24.1 ± 26.8 days. The 28-day mortality was 64.7%.
Conclusion: SOT recipients admitted to ICU with pneumonia are associated with poor prognosis. Most of the pneumonia episodes were seen 6 months after transplantation with high APACHE II scores predicting mortality.
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