BACKGROUND: Infections remain a major cause of morbidity and mortality after kidney transplantation. The aim of our study was to determine the effect of sepsis on kidney graft function and recipient mortality. METHODS: A prospective, observational, single-center study was performed. Selected clinical and biochemical parameters were recorded and compared between an experimental group (with sepsis, n = 34) and a control group (with systemic inflammatory response syndrome, n = 31) comprising kidney allograft recipients. RESULTS: Sepsis worsened both patient (HR = 14.77, p = 0.007) and graft survival (HR = 15.07, p = 0.007). Overall one-year mortality was associated with age (HR = 1.08, p = 0.048), APACHE II score (HR = 1.13, p = 0.035), and combination immunosuppression therapy (HR = 0.1, p = 0.006), while graft survival was associated with APACHE II (HR = 1.25, p = 0.004) and immunosuppression. In sepsis patients, mortality correlated with the maximal dose of noradrenalin (HR = 100.96, p = 0.008), fungal infection (HR = 5.64, p = 0.024), SAPS II score (HR = 1.06, p = 0.033), and mechanical ventilation (HR = 5.97, p = 0.033), while graft survival was influenced by renal replacement therapy (HR = 21.16, p = 0.005), APACHE II (HR = 1.19, p = 0.035), and duration of mechanical ventilation (HR = 1.01, p = 0.015). CONCLUSION: In contrast with systemic inflammatory response syndrome, septic kidney allograft injury is associated with early graft loss and may represent a significant risk of mortality.

1st Faculty of Medicine Charles University Prague Czechia

Department of Anesthesiology Resuscitation and Intensive Care Institute for Clinical and Experimental Medicine Prague Czechia

Department of Nephrology Transplant Centre Institute for Clinical and Experimental Medicine Prague Czechia

Transplantation Laboratory Experimental Medicine Centre Institute for Clinical and Experimental Medicine Prague Czechia

Zobrazit více v PubMed

Koordinační středisko transplantací. Coordination Center for Transplantation Czech Republic. Available online at: https://kst.cz/#co_ctime (accessed June 15, 2022) (2019).

Viklicky O, Fronek J, Trunecka P, Pirk J, Lischke R. Organ transplantation in the Czech Republic. Transplantation. (2017) 101:2259–61. 10.1097/TP.0000000000001871 PubMed DOI

Dharnidharka VR, Stablein DM, Harmon WE. Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS. Am J Transplant. (2004) 4:384–9. 10.1111/j.1600-6143.2004.00350.x PubMed DOI

Karuthu S, Blumberg EA. Common infections in kidney transplant recipients. Clin J Am Soc Nephrol. (2012) 7:2058–70. 10.2215/CJN.04410512 PubMed DOI

Moreno A, Cervera C, Gavalda J, Rovira M, de la Camara R, Jarque I, et al. Bloodstream infections among transplant recipients: results of a nationwide surveillance in Spain. Am J Transplant. (2007) 7:2579–86. 10.1111/j.1600-6143.2007.01964.x PubMed DOI

Kalil AC, Sandkovsky U, Florescu DF. Severe infections in critically ill solid organ transplant recipients. Clin Microbiol Infect. (2018) 24:1257–63. 10.1016/j.cmi.2018.04.022 PubMed DOI

Bodro M, Sabe N, Tubau F, Llado L, Baliellas C, Roca J, et al. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid organ transplant recipients. Transplantation. (2013) 96:843–9. 10.1097/TP.0b013e3182a049fd PubMed DOI

Bellomo R, Kellum JA, Ronco C, Wald R, Martensson J, Maiden M, et al. Acute kidney injury in sepsis. Intensive Care Med. (2017) 43:826–8. 10.1007/s00134-017-4755-7 PubMed DOI

Bagshaw SM, Lapinsky S, Dial S, Arabi Y, Dodek P, Wood G, et al. Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. (2009) 35:871–81. 10.1007/s00134-008-1367-2 PubMed DOI

Hjortrup PB, Haase N, Bundgaard H, Thomsen SL, Winding R, Pettila V, et al. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentter feasibility trial. Intensive Care Med. (2016) 42:1695–705. 10.1007/s00134-016-4500-7 PubMed DOI

De Backer D, Aldecoa C, Njimi H, Vincent J-L. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med. (2012) 40:725–30. 10.1097/CCM.0b013e31823778ee PubMed DOI

Asfar P, Meziani F, Hamel J-F, Grelon F, Megarbane B, Anguel N, et al. SEPSISPAM Investigators. High versus low blood pressure target in patiens with septic shock. N Engl J Med. (2014) 370:1583–93. 10.1056/NEJMoa1312173 PubMed DOI

Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Payenstadt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patiens with acute kidney injury: the ELAN randomised clinical trial. JAMA. (2016) 315:2190–9. 10.1001/jama.2016.5828 PubMed DOI

Tu GW, Ju MJ, Zheng YJ, Zhu DM, Xu M, Rong RM, et al. An interdisciplinary approach for renal transplant recipients with severe pneumonia: a single ICU experience. Intensive Care Med. (2014) 40:914–5. 10.1007/s00134-014-3296-6 PubMed DOI PMC

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. (2017) 43:304–77. 10.1007/s00134-017-4683-6 PubMed DOI

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. (2021) 49:e1063–143. PubMed

Schlapbach LJ, Kissoo N, Alhawsawi A, Aljuaid MH, Daniel R, Gorordo-Delso LA, et al. World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality. Am J Physiol Lung Cell Mol Physiol. (2020) 319:L518–22. 10.1152/ajplung.00369.2020 PubMed DOI

Wang M, Jiang L, Zhu B, Li W, Du B, Kang Y, et al. The prevalence, risk factors, and outcome of sepsis in critically ill patients in China: a multicenter prospective cohort study. Front Med. (2020) 7:593808. 10.3389/fmed.2020.593808 PubMed DOI PMC

Langenberg C, Bellomo R, May C, Wan L, Egi M, Morgera S. Renal blood flow in sepsis. Crit Care. (2005) 9:363–74. 10.1186/cc3540 PubMed DOI PMC

Greenberg JA, Hohmann SF, James BD, Shah RC, Hall JB, Kress JP, et al. Hospital volume of immunosuppressed patients with sepsis and sepsis mortality. Ann Am Thorac Soc. (2018) 15:962–9. 10.1513/AnnalsATS.201710-819OC PubMed DOI PMC

Bafi AT, Tomotani DYV. Rezende de Freitas FG. Sepsis in solid-organ transplant patients. Shock. (2017) 47(Suppl 1):12–6. 10.1097/SHK.0000000000000700 PubMed DOI

Donnelly JP, Locke JE, MacLennan PA, McGwin G, Jr., Mannon RB, Safford MM, et al. Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis. Clin Infect Dis. (2016) 63:186–94. 10.1093/cid/ciw295 PubMed DOI PMC

Kalil AC, Syed A, Rupp ME, Chambers H, Vargas L, Maskin A, et al. Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study. Clin Infect Dis. (2015) 60:1590. 10.1093/cid/ciu789 PubMed DOI

Chou NK, Ko WJ, Chi NH, Chen YS, Yu HY, Hsu RB, et al. Sparing immunosuppression in heart transplant recipients with severe sepsis. Transplant Proc. (2006) 38:2145–6. 10.1016/j.transproceed.2006.06.009 PubMed DOI

Bige N, Zafrani L, Lambert J, Peraldi MN, Snanoudj R, Reuter D, et al. Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis. (2014) 16:588–96. 10.1111/tid.12249 PubMed DOI

Kotagiri P, Chembolli D, Ryan J, Hughes PD, Toussaint ND. Urinary tract infections in the first year post-kidney transplantation: potential benefits of treating asymptomatic bacteriuria. Transplant Proc. (2017) 49:2070–5. 10.1016/j.transproceed.2017.07.008 PubMed DOI

Schachtner T, Stein M, Reinke P. Sepsis after renal transplantation: clinical, immunological, and microbiological risk factors. Transpl Infect Dis. (2017) 19:e12695. 10.1111/tid.12695 PubMed DOI