Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome.
- Author:
Yu Ji LEE
1
;
Na Ree KANG
;
Jung Eun LEE
;
Wooseong HUH
;
Sung Joo KIM
;
Yoon Goo KIM
;
Dae Joong KIM
;
Ha Young OH
Author Information
1. Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea. hayoung.oh@samsung.com
- Publication Type:Original Article
- Keywords:
Kidney transplantation;
Pyelonephritis;
Graft survival;
Risk factors
- MeSH:
Ceftriaxone;
Ciprofloxacin;
Escherichia coli;
Female;
Fever;
Follow-Up Studies;
Graft Survival;
Humans;
Kidney;
Kidney Transplantation;
Klebsiella;
Medical Records;
Pyelonephritis;
Rejection (Psychology);
Retrospective Studies;
Risk Factors;
Transplantation, Homologous;
Transplants;
Vesico-Ureteral Reflux
- From:Korean Journal of Nephrology
2009;28(4):310-316
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The objective of this study was to investigate the clinical manifestations and risk factors associated with acute graft pyelonephritis (AGPN) and its impact on graft outcome. METHODS: We performed a retrospective study reviewing the medical records of 272 recipients with a graft survival of more than 1 year among 291 recipients that had undergone kidney transplantation between January 1995 and December 1999. RESULTS: Twenty eight (10.3%) patients had at least one episode of AGPN during a follow-up of 7.3 years, and 14 (50%) among them had recurrent episodes. 31.5% of total AGPN episodes had no any urinary signs and symptoms and only had a fever and leukocyturia. Escherichia coli and Klebsiella, the most common pathogens isolated, were susceptible to ciprofloxacin in 48.6% of cases and to ceftriaxone in 94.3% of cases. Acute rejection was not associated with the occurrence of AGPN. However, female gender was a risk factor for acute rejection (risk ratio 7.11, p<0.001). Vesicoureteral reflux in allograft was found in 72.7% of the recipients with an episode of AGPN (16/22). There was a trend toward more frequent development of vesicoureteral reflux in recipients with recurrent AGPN episodes (54.6% in patients with a single episode vs 90.9% in patients with recurrent episodes, p= 0.074). On Cox regression/Time-dependent covariate analysis, AGPN had no significant association with the graft or patient survival. CONCLUSION: AGPN is common after kidney transplantation, especially in women. However, AGPN was not associated with a poor long-term graft outcome.
