Renal transplantation experience in the last 5 years in the adult intensive care department of the hospital de clínicas
Silene S Avila1, Jessica Figueredo1, Marcelo Pederzani1, Lorena Fontclara1, Federico Fretes1, Nestor Galeano1, Ricardo Caballero1, Fernando Ferreira1, Hugo Bianco1, Belinda Figueredo1.
1Departamento de Cuidados Intensivos Adultos, Hospital de Clínicas. Facultad de Ciencias Médicas. Universidad Nacional de Asunción, San Lorenzo, Paraguay
Introduction: In December 1985, the first renal transplant was performed at the Hospital de Clínicas. This multidisciplinary team continued to work in a coordinated manner to respond to the increasing needs of patients requiring this therapy.The objective of this paper is to expose the experience in renal transplants of the Adult Intensive Care Department of the Hospital de Clínicas of the Facultad de Ciencias Medicas from the Universidad Nacional de Asuncion in the last 5 years.
Methodology: An observational, descriptive, retrospective, and cross-sectional study was conducted. Medical records of all patients admitted to Adult Intensive Care in the postoperative period of renal transplantation from January 2017 to December 2021 were used.
Results: During the study period, 54 patients were submitted to renal transplantation, 72.2% of whom were male (n:39).The median age was 34 years old (IQR:21).Comorbidities were arterial hypertension 85.1% (n:46), hypothyroidism 9.2% (n:5), polycystic kidney disease 9.2% (n:5), diabetes mellitus 7.4% (n:4), glomerulonephritis 5.5% (n:3) and rheumatologic diseases 5.5% (n:3). The prognostic score used was APACHE II, with a median of 11 (IQR: 3).The median number of inpatient days was 3 (IQR:2).Mechanical ventilation was required in 7.4% of patients (n: 4) and the average number of ventilator days was 9 (range: 2-19).Continuous furosemide infusion was required in 50% of patients (n:27).Patients received vasopressors in 12.9% (n:7). Of the patients studied, 96.2% were on hemodialysis (n:52).The median pre-transplant creatinine was 9.5 mg/dl (IQR: 5.5), and post-transplant creatinine was 4.9 mg/dl (IQR: 5.1).The transplanted kidney came from a living donor in 38.9% (n:21) and from a cadaveric donor in 61.1% (n:33).Eight patients required post-transplant hemodialysis sessions, seven of them from cadaveric donors.Doppler ultrasound of the transplanted kidney showed renal artery stenosis in 12.9% (n:7), with clinical repercussions in 2 patients, leading to transplantectomy in one of them.Survival to discharge from the intensive care unit was a 100%.
Conclusion: Renal transplantation, both from living and cadaveric donors, is a valid therapeutic option with good results and low complications for patients with end-stage renal disease.
