Evaluation of risk factors and clinical outcomes of acute respiratory failure from post renal transplant recipients: A five-year data of a single center

Abstract

Acute Respiratory Failure (ARF) requiring Intensive Care Unit (ICU) admission is a common complication following renal transplant and is a diagnostic and therapeutic challenge. This study aimed to evaluate etiological factors and clinical outcomes of ARF following a renal transplant. This was a retrospective observational study. Data was recruited from last five –years’ records of Renal Transplant Unit of Dow University of Health Sciences, Karachi, Pakistan. Patients who developed ARF after renal transplantation whether requiring hospitalization (both in ICU or in ward) were included and their severity, etiologic diagnosis, and clinical outcomes were evaluated. During past five years (June 2017 till June 2023) a total of 450 kidney allografts were done and 35 patients (7.8%) developed ARF. Out of which 15 patients were shifted to the ICU. Mortality of female patients was higher as compared to males (26.1% versus 20.4%). Hypertension was found to be the most common comorbidity whereas glomerulonephritis was the most common cause of End Stage Renal Disease (ESRD).

Acute rejection was observed in 20.89% (n = 94) of recipients. Bacterial pneumonia was the most common cause of ARF, one patient needed on mechanical ventilation whereas two patients were dialysis dependent survivors. ARF following renal transplant is associated with higher mortality and loss of graft function because of compromised immunity. Anti-bacterial prophylaxis and early intensive management appears to help in improving the outcome while integrating the graft function.