Vujaklija Brajkovic A, Kosuta I, Batur L, Sundalic S, Medic M, Vujevic A, Bielen L, Babel J. Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study. World J Transplant 2025; 15(1): 98975 [DOI: 10.5500/wjt.v15.i1.98975]
Corresponding Author of This Article
Ana Vujaklija Brajkovic, MD, PhD, Assistant Professor, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. avujaklija@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2025; 15(1): 98975 Published online Mar 18, 2025. doi: 10.5500/wjt.v15.i1.98975
Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study
Ana Vujaklija Brajkovic, Iva Kosuta, Lucija Batur, Sara Sundalic, Marijana Medic, Andro Vujevic, Luka Bielen, Jaksa Babel
Ana Vujaklija Brajkovic, Iva Kosuta, Lucija Batur, Sara Sundalic, Marijana Medic, Andro Vujevic, Luka Bielen, Jaksa Babel, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Ana Vujaklija Brajkovic, Luka Bielen, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Co-first authors: Ana Vujaklija Brajkovic and Iva Kosuta.
Author contributions: Vujaklija Brajkovic A and Babel J designed the study; Kosuta I, Vujevic A, Batur L, Bielen L and Medic M collected the data; Vujaklija Brajkovic A, Kosuta I and Bielen L analyzed the data; Vujaklija Brajkovic A drafted the manuscript; Kosuta I, Sundalic S, Vujevic A, Batur L, Bielen L, Medic M and Babel J critically revised the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the University Hospital Centre Zagreb (Approval No Class 8.1-24/103-2, number 02/013 AG, date May 6th 2024).
Informed consent statement: Due to the retrospective nature of the study, the informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset is available from the corresponding author (avujaklija@gmail.com). The consent was not obtained but the presented data are anonymized, and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement-a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ana Vujaklija Brajkovic, MD, PhD, Assistant Professor, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. avujaklija@gmail.com
Received: July 11, 2024 Revised: September 27, 2024 Accepted: October 25, 2024 Published online: March 18, 2025 Processing time: 138 Days and 22.6 Hours
Abstract
BACKGROUND
Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life.
AIM
To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU).
METHODS
We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023.
RESULTS
The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [χ² (5, n = 141) = 18.513, P < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [χ² (1, n = 91) = 21.767, P < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [χ² (1, n = 91) = 17.081, P < 0.001] and vasopressor therapy [χ² (1, n = 91) = 36.803, P < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [χ² (1, n = 91) = 0.376, P = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%.
CONCLUSION
Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT.
Core Tip: Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) have significantly improved the survival and quality of life of numerous patients. We conducted a comprehensive study of 91 post-transplantation patients in a tertiary intensive care unit (ICU) and identified sepsis and septic shock as the main admission diagnoses. The necessity for mechanical ventilation and vasopressor therapy significantly impacted survival. The ICU survival rate was 57% in the SOT group and 12.7% in the HSCT group. Early recognition and prompt ICU admittance of post-transplant patients are crucial for improving outcomes, particularly following HSCT.
