Sepsis affects kidney graft function and one-year mortality of the recipients in contrast with systemic inflammatory response

Marek Protus; Eva Uchytilova; Veronika Indrova; Jan Lelito; Ondrej Viklicky; Petra Hruba; Eva Kieslichova

doi:10.3389/fmed.2022.923524

Sepsis affects kidney graft function and one-year mortality of the recipients in contrast with systemic inflammatory response

Front Med (Lausanne). 2022 Jul 29:9:923524. doi: 10.3389/fmed.2022.923524. eCollection 2022.

Authors

Marek Protus^{1

2}, Eva Uchytilova^{1

2}, Veronika Indrova¹, Jan Lelito¹, Ondrej Viklicky^{2

3}, Petra Hruba⁴, Eva Kieslichova^{1

2}

Affiliations

¹ Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia.
² First Faculty of Medicine, Charles University, Prague, Czechia.
³ Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia.
⁴ Transplantation Laboratory, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia.

Abstract

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.

Keywords: graft loss; kidney transplantation; mortality; sepsis; systemic inflammatory response syndrome.