Abstract
Background and Aims
Acute graft pyelonephritis(AGPN) is thought to affect graft and patient survival among renal transplant recipients. Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transplant)
Method
This retrospective study analyzed 150 patients who had AGPN over a period of 8 years from 2005 to 2013. They were divided into early AGPN group and late AGPN group. Their baseline characteristics were compared. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots
Results
A total of 150 patients with AGPN were analyzed. Of these 55.3% (n=83) had early AGPN and 44.7% (n=67) had late AGPN. These two groups were comparable regarding baseline characteristics and immunosuppression. In early AGPN group, 13.3% (n=11) patients had CMV disease during follow up compared to 3% (n=2) in late AGPN group(p<0.05). In the early AGPN group, 26.5% (n=22) had prolonged Foley’s catheterization (>5days) following transplant surgery compared to 7.5% (n=5) in late AGPN group (p<0.05). In the early AGPN group, 38.6% (n=32) had prolonged DJ stent in-situ (>2weeks) following transplant surgery compared to 19.4% (n=13) in the late AGPN group (p<0.05). Recurrent GPN was more common in the late AGPN group than the early AGPN group - 35.8% (n=24) versus 18.1% (n=15). Predictors for graft loss were assessed in patients with AGPN and the presence of renal abscess was predictive of graft loss in univariate analysis (HR-6.129, 95% CI 1.776–21.154, p-0.004). There were no significant predictors of mortality in univariate analysis. Kaplan Meier survival analysis showed decreased death censored graft survival in the early AGPN group (p-0.035). There was no
Conclusion
Occurrence of early AGPN had a significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival. This study underlines the paramount importance of the prevention of UTIs in renal transplant recipients.
Effect of FTY720 (fingolimod) on graft survival in renal transplant recipients: a systematic review protocol: Table 1
