• Jonathan Messika, Michael Darmon, Hervé Mal, Peter Pickkers, Marcio Soares, Emmanuel Canet, Jordi Rello, Philippe R Bauer, Andry van de Louw, Virginie Lemiale, Fabio Silvio Taccone, Loeches Ignacio Martin IM Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland, an, Peter Schellongowski, Sangeeta Mehta, Massimo Antonelli, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Fabrice Bruneel, Frédéric Pène, Victoria Metaxa, Anne Sophie Moreau, Gaston Burghi, Luca Montini, François Barbier, Lene B Nielsen, Djamel Mokart, Sylvie Chevret, Lara Zafrani, Elie Azoulay, and EFRAIM Investigators and the Nine-I Study Group.
• Pulmonology and Lung Transplant Unit, Hôpital Bichat-Claude Bernard, APHP.Nord- Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, Paris Transplant Group, F-75018 Paris, France. Electronic address: jonathan.messika@aphp.fr.
• Transplant. Proc. 2020 Dec 1; 52 (10): 2980-2987.

BackgroundRespiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU.MethodsIn this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1.ResultsAmong 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis.ConclusionsICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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