{
    "abstract": "Up to 6% of kidney transplant recipients (KTRs) experience life-threatening complications requiring intensive care unit (ICU) admission, and one of the most common medical complications requiring ICU admission is infection. This study aimed to evaluate the effect of immunosuppressive therapy (IST) modification on prognosis of KTRs with sepsis.\nWe conducted a multicenter retrospective study in 4 university-affiliated hospitals to evaluate the effect of adjusting the IST in KTRs with sepsis. Only patients who either maintained IST after ICU admission or those who underwent immediate (within 24\u2005h of ICU admission) reduction or withdrawal of IST following ICU admission were included in this study. \"Any reduction\" was defined as a dosage reduction of any IST or discontinuation of at least 1 IST. \"Complete withdrawal of IST\" was defined as concomitant discontinuation of all ISTs, except steroids.\nDuring the study period, 1596 of the KTRs were admitted to the ICU, and 112 episodes of sepsis or septic shock were identified. The overall in-hospital mortality rate was 35.7%. In-hospital mortality was associated with higher sequential organ failure assessment score, simplified acute physiology score 3, non-identical human leukocyte antigen relation, presence of septic shock, and complete withdrawal of IST. After adjusting for potential confounding factors, complete withdrawal of IST remained significantly associated with in-hospital mortality (adjusted coefficient, 1.029; 95% confidence interval, 0.024-2.035) and graft failure (adjusted coefficient, 2.001; 95% confidence interval, 0.961-3.058).\nComplete IST withdrawal was common and associated with worse outcomes in critically ill KTRs with sepsis.",
    "authors": [
        {
            "affiliation": "Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.",
            "firstname": "Hyung Duk",
            "initials": "HD",
            "lastname": "Kim"
        },
        {
            "affiliation": "Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.",
            "firstname": "Byung Ha",
            "initials": "BH",
            "lastname": "Chung"
        },
        {
            "affiliation": "Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.",
            "firstname": "Chul Woo",
            "initials": "CW",
            "lastname": "Yang"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.",
            "firstname": "Seok Chan",
            "initials": "SC",
            "lastname": "Kim"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.",
            "firstname": "Kyung Hoon",
            "initials": "KH",
            "lastname": "Kim"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.",
            "firstname": "Shin Young",
            "initials": "SY",
            "lastname": "Kim"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea.",
            "firstname": "Kyu Yean",
            "initials": "KY",
            "lastname": "Kim"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.",
            "firstname": "Jongmin",
            "initials": "J",
            "lastname": "Lee"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1177/08850666241231495",
    "journal": "Journal of intensive care medicine",
    "keywords": [
        "immunosuppressants",
        "immunosuppressive therapy",
        "kidney transplant recipients",
        "kidney transplantation",
        "sepsis",
        "solid organ transplant"
    ],
    "methods": null,
    "publication_date": "2024-02-07",
    "pubmed_id": "38321761",
    "results": "During the study period, 1596 of the KTRs were admitted to the ICU, and 112 episodes of sepsis or septic shock were identified. The overall in-hospital mortality rate was 35.7%. In-hospital mortality was associated with higher sequential organ failure assessment score, simplified acute physiology score 3, non-identical human leukocyte antigen relation, presence of septic shock, and complete withdrawal of IST. After adjusting for potential confounding factors, complete withdrawal of IST remained significantly associated with in-hospital mortality (adjusted coefficient, 1.029; 95% confidence interval, 0.024-2.035) and graft failure (adjusted coefficient, 2.001; 95% confidence interval, 0.961-3.058).",
    "title": "Management of Immunosuppressive Therapy in Kidney Transplant Recipients with Sepsis: A Multicenter Retrospective Study.",
    "xml": "<Element 'PubmedArticle' at 0x78850217b740>"
}