Effect of temporary suspension of chronic immunosuppressive drugs on day-90 mortality and ICU-acquired infections among critically Ill patients with solid organ transplant: a retrospective multicenter study
| dc.contributor.author | Szychowiak, Piotr | |
| dc.contributor.author | Lacherade, Jean-Claude | |
| dc.contributor.author | Vaidie, Julien | |
| dc.contributor.author | François, Bruno | |
| dc.contributor.author | Pene, Frédéric | |
| dc.contributor.author | Vignon, Philippe | |
| dc.contributor.author | Evrard, Bruno | |
| dc.contributor.author | Zalucky, Ann | |
| dc.contributor.author | Gabriel, Anthony | |
| dc.contributor.author | Péju, Edwige | |
| dc.contributor.author | Guillon, Antoine | |
| dc.contributor.author | Demiselle, Julien | |
| dc.contributor.author | Asfar, Pierre | |
| dc.contributor.author | Guillot, Pauline | |
| dc.contributor.author | Delange, Boris | |
| dc.date.accessioned | 2025-12-31T12:52:29Z | |
| dc.date.available | 2025-12-31T12:52:29Z | |
| dc.date.issued | 2025-07-16 | |
| dc.description | Purpose: Decision-making for management of immunosuppressive drugs in solid organ transplant patients admitted to the ICU remains controversial. This study aimed to evaluate the impact of a temporary suspension strategy (interruption of immunosuppressive drugs > 24h) on day-90 mortality and ICU-acquired infections.Methods: This multicenter observational retrospective study conducted in solid organ transplant patients admitted to nine ICUs used a Bayesian approach with priors based on a belief elicitation process conducted among a panel of experts.Results: Among 591 enrolled patients, suspension strategy was used in 34% of them, during a median period of 5 days [IQR: 3-10]. This approach was more common in patients admitted for sepsis (38%) or COVID-19 (49%) than for non-septic causes (24%) (p < 0.001). Overall, day-90 mortality reached 30%, and Bayesian analysis revealed substantial uncertainty with an OR at 1.13 (95% Credible Interval (CrI): 0.74-1.70), and a 15% probability of a beneficial effect. In the subgroup of patients with sepsis, OR was at 0.90 (95% CrI: 0.55-1.55), with a 50% probability of a beneficial effect. ICU-acquired infections occurred in 26% of patients. The suspension strategy indicated a potential benefit, both in the entire cohort, with a 73% probability of a beneficial effect [OR: 0.74 (95% CrI: 0.49-1.15)], and in the subgroup of sepsis patients with a 78% probability of beneficial effect [OR 0.70 (95% CrI, 0.42-1.16)].Conclusion: Temporary suspension of immunosuppressive drugs may reduce the risk of ICU-acquired infections, with a true uncertainty on day-90 mortality. Prospective studies are warranted to confirm these results. | |
| dc.description.epage | 1452 | |
| dc.description.spage | 1442 | |
| dc.description.volume | 51 | |
| dc.identifier.doi | 10.1007/s00134-025-08024-7 | |
| dc.identifier.issn | 1432-1238 | |
| dc.identifier.uri | https://ror.circle-u.eu/handle/123456789/1690815 | |
| dc.openaire.affiliation | Université Paris Cité | |
| dc.openaire.collaboration | 1 | |
| dc.publisher | Springer Science and Business Media LLC | |
| dc.rights | CLOSED | |
| dc.rights.license | c_14cb | |
| dc.source | Intensive Care Medicine | |
| dc.subject | Immunosuppression | |
| dc.subject | Internal medicine | |
| dc.subject | Cohort study | |
| dc.subject | Immunosuppressive agents | |
| dc.subject | Treatment outcome | |
| dc.subject | Intensive care medicine | |
| dc.subject | Emergency medicine | |
| dc.subject | Medicine | |
| dc.subject | Nosocomial infections | |
| dc.subject | Observational study | |
| dc.subject | Sepsis | |
| dc.subject | Critical care | |
| dc.subject | Organ transplantation | |
| dc.subject | [SDV.IB] Life Sciences [q-bio]/Bioengineering | |
| dc.subject | Retrospective cohort study | |
| dc.title | Effect of temporary suspension of chronic immunosuppressive drugs on day-90 mortality and ICU-acquired infections among critically Ill patients with solid organ transplant: a retrospective multicenter study | |
| dc.type | publication |