Internações no Primeiro Ano Após o Transplante Renal: Avaliação de Fatores de Risco, Causas e Desfechos

Víctor Mendes Ferreira; Clarice de Carvalho Silva Sarcinelli; Andre de Sousa Alvarenga

Autores

Víctor Mendes Ferreira Hospital Dilson Godinho – Serviço de Nefrologia – Montes Claros (MG) – Brasil. https://orcid.org/0000-0001-5778-5062
Clarice de Carvalho Silva Sarcinelli Santa Casa de Misericórdia de Belo Horizonte – Serviço de Nefrologia – Belo Horizonte (MG) – Brasil. https://orcid.org/0000-0003-1954-7500
Andre de Sousa Alvarenga Santa Casa de Misericórdia de Belo Horizonte – Serviço de Nefrologia – Belo Horizonte (MG) – Brasil. https://orcid.org/0000-0002-4854-9460

Palavras-chave:

Transplante de Rim, Hospitalização, Infecções Oportunistas

Resumo

Objetivos: Este estudo objetivou avaliar as causas de internação no 1^o ano após o transplante renal em um hospital público. Métodos: Trata-se de coorte retrospectiva feita por meio da revisão de prontuários médicos. Os critérios de inclusão foram 18 anos de idade ou mais e transplante renal. Os critérios de exclusão foram transplante duplo, falência primária do enxerto e óbito durante a internação para transplante. Os desfechos avaliados incluíram sobrevida global em 4 anos (desfecho primário), falência do enxerto em 1 ano e função do enxerto em 1 ano. Resultados: Dentre os 130 pacientes, predominavam osexo masculino, glomerulonefrite como etiologia, histórico de hemodiálise, primeiro transplante renal e rim de doador falecido. A taxa de internação no 1^o ano após o transplante foi de 71,5%. Houve três óbitos na primeira internação (dois por eventos cardiovasculares). As principais causas de internação foram infecções, rejeição e complicações cirúrgicas. Causas menos comuns incluíam procedimentos eletivos, como a retirada do cateter de diálise peritoneal. Nenhuma das variáveis avaliadas teve associação estatisticamente significativa com risco aumentado para internação. Além disso, a ocorrência de internação não teve impacto na sobrevida global em 4 anos após o transplante (desfecho primário) e tampouco no risco de falência do enxerto em 1 ano. Porém, houve impacto negativo na função do enxerto ao final do 1o ano (tanto com o valor de creatinina quanto pela taxa de filtração glomerular estimada, com p < 0,05). Conclusão: Houve elevada frequência de internações, tendo a primeira resultado em óbito em três casos, nenhum de causa infecciosa. Considerando a contribuição de procedimentos considerados eletivos para tal estatística, propõe-se o investimento em resolutividade no nível ambulatorial em situações como retirada de cateter de Tenckhoff, tratamento dos casos leves de infecção pelo citomegalovírus (CMV ) e biópsia do enxerto renal.

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Referências

Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI) conference. Clin J Am Soc Nephrol 2008; 3: 471-80. https://doi.org/10.2215/CJN.05021107

Schnuelle P, Lorenz D, Trede M, Van der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol 1998; 9: 2135-41. https://doi.org/10.1681/ASN.V9112135

Ojo AO, Port FK, Wolfe RA, Mauger EA, Williams L, Berling DP. Comparative mortality risks of chronic dialysis and cadaveric transplantation in black end-stage renal disease patients. Am J Kidney Dis 1994; 24: 59-64. https://doi.org/10.1016/ S0272-6386(12)80160-0

Rabbat CG, Thorpe KE, Russell JD, Churchill DN. Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol 2000; 11: 917-22. https://doi.org/10.1681/ASN.V115917

Teixeira JP, Combs SA, Teitelbaum I. Peritoneal dialysis: update on patient survival. Clin Nephrol 2015; 83: 1-10. https://doi.org/10.5414/CN108382

Sukul N, Mukhopadhyay P, Schaubel DE, Pearson J, Turenne M, Saran R, et al. Peritoneal dialysis and mortality, kidney transplant, and transition to hemodialysis: trends from 1996-2015 in the United States. Kidney Med; 2: 610-9. https://doi.org/10.1016/j.xkme.2020.06.009

Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. J Am Med Assoc 1993; 270: 1339-43. https://doi.org/10.1001/jama.1993.03510110079036

United States Renal Data System [homepage na Internet]. Annual Data Report: mortality and causes of death [Atualizado em: Nov 2019, accessado em: Ago 22 2022]. Available from:www.usrds.org/annual-data-report/

Boenink R, Stel VS, Waldum-Grevbo BE, Collart F, Kerschbaum J, Heaf JG, et al. Data from the ERA-EDTA Registry was examined for trends in excess mortality in European adults on kidney replacement therapy. Kidney Int 2020; 98: 999-1008. https://doi.org/10.1016/j.kint.2020.05.039

Ying T, Shi B, Kelly PJ, Pilmore H, Clayton PA, Chadban SJ. Death after kidney transplantation: an analysis by era and time post-transplant. J Am Soc Nephrol 2020; 31: 2887-99. https://doi.org/10.1681/ASN.2020050566

Yagisawa T, Mieno M, Ichimaru N, Morita K, Nakamura M, Hotta K, et al. Trends of kidney transplantation in Japan in 2018: data from the kidney transplant registry. Ren Replace Ther 2019;5:1-14. https://doi.org/10.1186/s41100-019-0199-6

United States Renal Data System [homepage na Internet]. 2019 USRDS Annual Data Report: epidemiology of kidney disease in the United States [Atualizado em: Nov 2019; Acessado em: Ago 22 2022]. Available from:https://www.usrds.org/annual-data-report/

Schmidt-Lauber C, Günster C, Huber TB, Spoden M, Grahammer F. Collateral effects and mortality of kidney transplant recipients during the COVID-19 pandemic. Kidney360 2022; 3: 325-36. https://doi.org/10.34067/KID.0006472021

Requião-Moura LR, Sandes-Freitas TV, Viana LA, Cristelli MP, Andrade LGM, Garcia VD, et al. High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: results from the Brazilian multicenter cohort study. PLoS ONE 2021; 16: 1-20. https://doi.org/10.1371/journal.pone.0254822

Farrugia D, Cheshire J, Begaj I, Khosla S, Ray D, Sharif A. Death within the first year after kidney transplantation: an observational cohort study. Transpl Int 2014; 27: 262-70. https://doi.org/10.1111/tri.12218

Prihodova L, Nagyova I, Rosenberger J, Majernikova M, Roland R, Groothoff JW, et al. Adherence in patients in the first year after kidney transplantation and its impact on graft loss and mortality: a cross-sectional and prospective study. J Adv Nurs 2014; 70: 2871-83. https://doi.org/10.1111/jan.12447

Tavares MG, Tedesco-Silva Junior H, Pestana JOM. Readmissão hospitalar precoce no transplante renal: artigo de revisão. J Bras Nefrol 2020; 42: 231-7. https://doi.org/10.1590/2175-8239-JBN-2019-0089

Pestana JM. A pioneering healthcare model applying large-scale production concepts: principles and performance after more than 11,000 transplants at Hospital do Rim. Rev Assoc Med Bras 2016; 62: 664-71. https://doi.org/10.1590/1806- 9282.62.07.664

Boubaker K, Harzallah A, Ounissi M, Becha M, Guergueh T, Hedri H. Rehospitalization after kidney transplantation during the first year: length, causes and relationship with long-term patient and graft survival. Transplant Proc 2011; 43: 1742-6. https://doi.org/10.1016/j.transproceed.2011.01.178

Nguyen MC, Avila CL, Brock GN, Benedict JA, James I, El-Hinnawy A, et al. "Early" and "late" hospital readmissions in the first year after kidney transplant at a single center. Clin Transplant 2020; 34: 1-11. https://doi.org/10.1111/ctr.13822

Kim SH, Baird GL, Bayliss G, Merhi B, Osband A, Gohh R, et al. A single-center analysis of early readmission after renal transplantation. Clin Transplant 2019; 33: 1-6. https://doi.org/10.1111/ctr.13520

Weeda ER, Su Z, Taber DJ, Bian J, Morinelli TA, Pilch NA, et al. Hospital admissions and emergency department visits among kidney transplant recipients. Clin Transplant 2019; 33: e13522. https://doi.org/10.1111/ctr.13522

Wongtanasarasin W, Phinyo P. Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic: a hospital-based study. World J Transplant 2022;12: 250-8. https://doi.org/10.5500/wjt.v12.i8.250

Tavares MG, Cristelli MP, Paula MI, Viana L, Felipe CR, Proença H, et al. Early hospital readmission after kidney transplantation under a public health care system. Clin Transplant 2019; 33: e13467. https://doi.org/10.1111/ctr.13467

Tavares MG, Cristelli MP, Taddeo J, Tedesco-Silva Junior H, Pestana JM. The impact of universal induction therapy on early hospital readmission of kidney transplant recipients. Braz J Nephrol 2023; 45: 218-28. https://doi.org/10.1590%2F2175-8239-JBN-2022-0042en

Luan FL, Barrantes F, Roth RS, Samaniego M. Early hospital readmissions post-kidney transplantation are associated with inferior clinical outcomes. Clin Transplant 2014; 28: 487-93. https://doi.org/10.1111/ctr.12347

Lubetzky M, Yaffe H, Chen C, Ali H, Kayler LK. Early readmission after kidney transplantation: examination of discharge- level factors. Transplantation 2016; 100: 1079-85. https://doi.org/10.1097/tp.0000000000001089

McAdams-DeMarco MA, Grams ME, Hall EC, Coresh J, Segev DL. Early hospital readmission after kidney transplantation: patient and center-level associations. Am J Transplant 2012; 12: 3283-8. https://doi.org/10.1111/j.1600-6143.2012.04285.x

Kang IC, Kim IK, Son S, Ju MK. Impact of early hospital readmissions after kidney transplantation on graft function. Transplant Proc 2017; 50: 2359-62. https://doi.org/10.1016/j.transproceed.2017.12.062

Famure O, Kim ED, Li Y, Huang JW, Zyla R, Au M, et al. Outcomes of early hospital readmission after kidney transplantation: perspectives from a Canadian transplant centre. World J Transplant 2023; 13: 357-67. https://doi.org/10.5500/wjt.v13.i6.357

King EA, Bowring MG, Massie AB, Kucirka LM, McAdams-DeMarco MA, Al-Ammary F, et al. Mortality and graft loss attributable to readmission after kidney transplantation: immediate and long-term risk. Transplantation 2017; 101: 2520-6. https://doi.org/10.1097/tp.0000000000001609