Introduction: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. The oXiris® is a novel filter for continuous renal replacement therapy (CRRT) to improve the prognosis and reduce the inflammatory response of solid organ transplant recipients with septic shock. This study reported our experiences with the use of the oXiris® hemofilter for liver transplant recipients (LTr) and renal transplant recipients (RTr) with septic shock requiring CRRT in intensive care unit (ICU).
Material and Method: This retrospective study evaluated adult LTr and RTr with septic shock requiring CRRT with the oXiris® hemofilter from January 2019 to January 2024.
Results: During study period, liver transplantation was performed to 113 patients and renal transplantation was performed to 296 patients in our center. Seventeen of these patients (4.2%) underwent CRRT with the oXiris® hemofilter due to septik shock in early and late posttransplantation periods in ICU. Thirteen patients (76.5%) were male and the mean age was 47.7±12.9 years old. Of these patients, 14 (82.4%) were RTr and 3 (17.6%) were LTr. Twelve patients (70.6%) had medical etiologies and 5 patients (29.4%) had surgical causes. The most common reasons for ICU readmission were respiratory problems (n = 12, 70.6%). Seven patients (41.2%) each had stage 2 and stage 3 AKI. Metabolic acidosis (n=10, 58.8%) was the most common indication for CRRT. The duration from ICU admission to CRRT was 3.3±4.7 hours. The modality of CRRT was CVVHDF in 16 patients. When the serum levels before and after usage of oXiris® hemofilter were compared, no statistically significant decrease was observed in CRP, leukocyte and procalcitonin values (p>0.05). Twelve patients (70.6%) had pneumonia, 4 patients (23.5%) had urinary tract infection, and 1 patients (5.9%) had cholangitis. The most common bacteria was Klebsiella pneumoniae (29.4%). Seventen point six percent of isolated bacteria were MDR, 23.5% XDR and 11.8% PDR. The mean length of ICU and hospital stays were 7.8±4.9 and 17.6 ±11.2 days respectively.
Conclusion: Our incidence of oXiris® hemofilter usage among LTr and RTr during the posttransplantation period was 4.2%. No adverse events was observed without significant change in biochemical parameters. Our case series indicate that CRRT with the adsorbing membrane oXiris® may be used during organ transplant recipients with sepsis.