Maintenance Immunosuppressive Treatment of Renal Transplant Recipients in the Critical Care Unit

In intensive care unit (ICU), although there is no standard protocol for maintenance of immunosuppressive (IS) treatments for the kidney transplant recipients (KTx), the dose and the number of IS drugs are decreased according to the center’s experience. The aim of this study is to evaluate the chang...

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Bibliographic Details
Published in:Transplantation proceedings 2019-09, Vol.51 (7), p.2358-2360
Main Authors: Sarıtaş, Hazen, Şendoğan, Damla Örs, Kumru, Gizem, Eyüboğlu, Şahin, Altıntaş, Neriman Defne, Kocaay, Akin Fırat, Tüzüner, Acar, Şengül, Şule, Keven, Kenan
Format: Article
Language:English
Subjects:
Adult
Clinical Protocols
Critical Care - methods
Drug Therapy, Combination
Female
Humans
Immunosuppressive Agents - therapeutic use
Intensive Care Units - statistics & numerical data
Kidney Transplantation
Male
Middle Aged
Mycophenolic Acid - therapeutic use
Postoperative Period
Retrospective Studies
Steroids - therapeutic use
Tacrolimus - therapeutic use
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Summary:In intensive care unit (ICU), although there is no standard protocol for maintenance of immunosuppressive (IS) treatments for the kidney transplant recipients (KTx), the dose and the number of IS drugs are decreased according to the center’s experience. The aim of this study is to evaluate the changes in IS treatment during stays in the ICU and to evaluate the safety and results of this modification on the IS treatment in the ICU arbitrarily. We evaluated retrospectively our kidney transplant recipients in ICU between 2012 and 2017. The immunosuppressive protocols and the results were taken from the ICU documents. A total of 31 (18 male, 13 female) patients were suitable for the analysis. They were all under the triple IS protocol including Tacrolimus (Tac) + Mycophenolate mofetil (MMF) + steroid before the admission. The reason for ICU admission were severe sepsis in all patients. In ICU, 16 patients (51.6%) died, and a total of 10 patients were lost with functional graft. Change in IS treatment is as follows: a total of the 23 patients (74.2%) were given only steroids, and 8 patients (25.8%) were changed from triple to 2 drugs. Acute kidney injury developed in 42% (13 patients) of the patients in ICU. In our study, we observed that life-threatening severe infections were the main cause of ICU admission in KTx. Reduction in IS treatments are common practice, and reduction to a single dose of steroid was the most frequently chosen IS treatment. Eighty percent of patients are discharged with reduction of steroid gradually. None of the patients developed acute rejection and permanent graft injury. •During intensive care unit (ICU) admission, transplant nephrologists and surgeons take care of their patients by prescribing an immunosupressive treatment individually, balancing life-threatening sepsis and rejection prevention.•The main reason for admission of renal transplant recipients to the ICU was a life-threatening infection.•In the ICU, kidney trasnplant recipients need individualized maintenance IS treatment based on the severity of the life-threatening condition.•We showed that a single-dose steroid was the most frequently used modification of maintenance IS treatments for kidney transplant recipients in the ICU.•In our series, lower doses of maintenance immunosuppression seem safe and suitable for kidney transplant recipients.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2019.03.052