The burden of critical illness in kidney transplant recipients—beyond 1 year post-transplant

Patients with chronic kidney disease who undergo kidney transplantation are at risk of acute illness, acute graft failure, and intensive care admission in the years following transplantation. To identify individual risk factors, assess the effect of immunosuppression, and evaluate outcomes including loss of graft function in a European setting, we analyzed 266 intensive care unit (ICU) admissions of kidney transplant recipients (KTRs) with severe illness between 2005 and 2019. Admission to the ICU occurred predominantly 12 months or later after transplantation, with a median time of 52.7 months. Overall mortality was 12.8% and was associated with infections in 70.6% of cases. Acute immunosuppressive therapy for rejection, rather than primary induction or immunosuppressive regimens, correlated with critical illness in 53% of cases. The median time to ICU admission was 1.2 years. Of the survivors, 12.1% lost graft function and remained on dialysis at discharge. In univariate and multivariate analyses, we found that SAPS (Simplified Acute Physiology Score) II values and vasopressor use were significantly associated with mortality. Overall, KTRs are at risk of critical illness, especially beyond 1 year post-transplant. Rejection therapy and older age increase the risk of critical illness.