Our study has several limitations. First, we used a retrospective design. However, selleck catalog data collection was done specifically for this study and by the same investigator (EC) in the nine centers. Second, we included patients over an 8-year period, during which changes in treatment practices probably occurred. For instance, at ICU admission, 86.7% of our patients were on corticosteroid therapy. The use of newer immunosuppressive agents such as sirolimus, mycophenolate mofetil, T-cell and B-cell depletion and costimulatory blockade has led to a substantial number of patients being treated without long-term steroid therapy [6,19]. Third, one-fourth of our patients had cardiogenic pulmonary edema, in keeping with the high rate of cardiovascular comorbidities.

Pulmonary edema does not require invasive diagnostic procedures and differs in its overall management from other causes of ARF. However, cardiogenic pulmonary edema may occur concomitantly with infection. Moreover, the aim of our study was to provide clinicians with data relevant to their everyday practice. Therefore, we included patients with ARF due to cardiogenic pulmonary edema. The strengths of our study include the multicenter design, including nine participating transplant centers, all of which had extensive experience with managing medical complications in kidney transplant recipients. Furthermore, the participating ICUs had considerable experience in managing immunocompromised patients with ARF [28,42,43].ConclusionsIn summary, medical complications requiring ICU admission occurred in 6.

6% of kidney transplant recipients, and ARF accounted for one-half of these admissions. Bacterial pneumonia, cardiogenic pulmonary edema, and ALI or ARDS related to extrapulmonary sepsis were the leading causes of ARF. Pneumocystis pneumonia was common and severe. By day 90 after ICU discharge, mortality was 22.5%, 20% of the patients had lost their transplant and only 37.5% of patients had recovered their pre-ICU renal function. Patient survival correlated with acute illness severity and the cause of ARF. Graft survival correlated with previous graft function, pulmonary disease severity and the cause of ARF. Our data suggest that extended chemoprophylaxis for bacterial and fungal infection and early ICU admission of patients with ARF may improve outcomes.

Key messages? Acute respiratory failure accounts for one-half of the ICU admissions in recipients of kidney transplantation.? 90-day mortality is 22.5%, but a one-fourth of survivors have lost their graft.? In the early posttransplant period (< 1 month) cardiogenic pulmonary edema accounted Entinostat for one-half of the diagnoses, while opportunistic fungal infections and drug-related pulmonary toxicity were mostly diagnosed in the late posttransplant period (> 6 months).? Fiberoptic bronchoscopy and bronchoalveolar lavage led to the diagnosis in 45.5% of cases.