ACUTE-RENAL-FAILURE IN RECIPIENTS OF ORGAN-TRANSPLANTATION AND NONTRANSPLANTATION PATIENTS - COMPARISON OF CHARACTERISTICS AND MORTALITY

Mortality from acute renal failure in critically ill patients remains in excess of 50% despite decades of improvement in supportive care. It is not known whether replacement of other failing organs by non-renal organ transplantation affects mortality in acute renal failure. We re trospectively reviewed the course of 169 patients with acute renal fai lure managed at a single university medical center over a 1-year perio d. Measures of disease severity (need for renal replacement therapy, m echanical ventilation or parenteral nutrition, presence of oliguria an d APA CHE II scores) and final outcome were compared in 97 patients wi th acute renal failure who did not receive transplants and 72 patients with acute renal failure who underwent non-renal solid organ transpla nts. Overall mortality was 50.3% and directly correlated with APACHE I I score. Compared to nontransplant patients, transplant recipients wer e younger more frequently male, and less often oliguric; but the group s were similar in mean APACHE II scores and need for renal replacement therapy, prolonged mechanical ventilation, and parenteral nutrition. Overall, mortality was significantly lower for transplant patients com pared to nontransplant patients 34.7% vs. 61.9%, p < 0.05). In nonolig uric acute renal failure and renal failure not requiring renal replace ment therapy, mortality was low and similar in both transplant and non transplant patients. Compared to nontransplant patients with similar r isk factors and similar APACHE II scores, mortality was significantly lower for transplant patients who were oliguric, and who required rena l replacement therapy, mechanical ventilation, or parenteral nutrition . Organ transplantation is associated with a survival advantage in acu te renal failure when compared to the outcome of critically ill nontra nsplant patients. The relation between APACHE II scores and survival i s altered by transplantation.