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KMID : 0359920090280040310
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Korean Journal of Nephrology
2009 Volume.28 No. 4 p.310 ~ p.316
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Acute Graft Pyelonephritis after Kidney Transplantation: Clinical Manifestations and the Impact on Long-term Allograft Outcome
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Lee Yu-Ji
Kang Na-Ree
Lee Jung-Eun
Huh Woo-Seong
Kim Sung-Joo
Kim Yoon-Goo
Kim Dae-Joong
Oh Ha-Young
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Abstract
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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.
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KEYWORD
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Kidney transplantation, Pyelonephritis, Graft survival, Risk factors
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