Acute graft pyelonephritis in renal transplant recipients: incidence, risk factors and long-term outcome

The influence of acute graft pyelonephritis (AGPN) on graft outcome in renal transplant recipients still remains controversial. We retrospectively analysed 189 patients (113 males; mean age: 49.7 ± 13.1 years) undergoing renal transplantation at the University Hospital 12 de Octubre (Madrid, Spain)...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2011-03, Vol.26 (3), p.1065-1073
Main Authors: FIORANTE, Silvana, FERNANDEZ-RUIZ, Mario, LOPEZ-MEDRANO, Francisco, LIZASOAIN, Manuel, LALUEZA, Antonio, MORALES, Jose Maria, SAN-JUAN, Rafael, ANDRES, Amado, OTERO, Joaquin R, AGUADO, Jose Maria
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cohort Studies
Creatinine - blood
Emergency and intensive care: renal failure. Dialysis management
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection - etiology
Graft Survival
Humans
Incidence
Intensive care medicine
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - surgery
Kidney Function Tests
Kidney Transplantation - adverse effects
Male
Medical sciences
Middle Aged
Postoperative Complications
Pyelonephritis - etiology
Retrospective Studies
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival Rate
Treatment Outcome
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Summary:The influence of acute graft pyelonephritis (AGPN) on graft outcome in renal transplant recipients still remains controversial. We retrospectively analysed 189 patients (113 males; mean age: 49.7 ± 13.1 years) undergoing renal transplantation at the University Hospital 12 de Octubre (Madrid, Spain) from January 2002 to December 2004, with a minimum follow-up of 36 months. Factors associated with AGPN were assessed by logistic regression analysis. Long-term graft function was compared according to the occurrence of this complication during follow-up. 'Decline in renal graft function' was defined as the increase in serum creatinine (SC) levels > 0.33 mg/dL between Month 3 and Year 1 after transplantation. Nineteen patients (10.0%) were diagnosed with 25 episodes of AGPN (incidence rate: 4.4 episodes per 100 patient-years). The presence of glomerulonephritis as the underlying disease [odds ratio (OR) 4.2; 95% confidence interval (95%CI): 1.3-14.1] and the previous occurrence of two to five (OR 9.4; 95%CI: 1.5-56.8) or more than five episodes of asymptomatic bacteriuria after transplantation (OR 19.8; 95%CI: 2.4-160.2) emerged as independent predictors for AGPN. A near-significant association was found for cytomegalovirus infection (OR 4.2; 95%CI: 0.9-18.4), whereas receiving a single-kidney transplant (vs. double-kidney) showed a protective effect (OR 0.2; 95%CI: 0.0-0.8). During the 36-month follow-up, levels of SC, creatinine clearance and 24-h proteinuria did not differ significantly between patients with or without AGPN, and this complication did not exert any effect on the risk for decline in renal graft function. AGPN does not impair long-term graft function in renal transplant recipients.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfq531