Kroth L V, Barreiro F F, Saitovitch D, Traesel M A, d'Avila D O L, Poli-de-Figueiredo C E
Programa de Pós-graduação em Medicina e Ciências da Saúde, FAMED/IPB/HSL, Pontifícia Universidade Católica do Rio Grande do Sul (Nefrologia), Porto Alegre, Brazil.
Programa de Pós-graduação em Medicina e Ciências da Saúde, FAMED/IPB/HSL, Pontifícia Universidade Católica do Rio Grande do Sul (Nefrologia), Porto Alegre, Brazil.
Transplant Proc. 2016 Sep;48(7):2298-2300. doi: 10.1016/j.transproceed.2016.06.016.
Acute graft pyelonephritis is a very common infection in renal transplantation. The impact of acute graft pyelonephritis (AGPN) on graft and patient outcome has not yet been established. Eight hundred seventy kidney and kidney-pancreas transplants were retrospectively studied, over last 13 years, to verify occurrence of AGPN in the first 30 days post-transplantation. We found that 112 patients (15.8%) presented post-transplantatiom AGPN up to 30 days after a kidney transplantation. The occurrence was higher in older patients (P = .005) and in those with ureteral stents (P = .06). Escherichia coli was the most frequent microorganism in urine cultures (32%). Ureteral stent (relative risk = 1.7; confidence interval [CI], 1.1-2.5; P = .018) was a major risk factor for AGPN as well as older ages (RR = 1.02; CI 1.01-1.04; P = .001), length of hospitalization stay (RR = 1.01; CI, 1.01-1.02; P < .001), and anti-thymocyte globulin (ATG) induction (RR = 1.6; CI, 1.022-2.561; P = .04). Long-term graft and patient survival was significantly lower in patients with pyelonephritis in the first 30 days after transplantation (OR 1.43; 95% CI, 0.95-2.16; P = .024 and OR 1.77; 95% CI, 1.12-2.80; P = .006, respectively). Acute pyelonephritis in the first 30 days after transplantation is therefore associated with a lower long-term graft and patient survival.
急性移植肾盂肾炎是肾移植中一种非常常见的感染。急性移植肾盂肾炎（AGPN）对移植肾和患者预后的影响尚未明确。对过去13年里的870例肾移植和肾 - 胰联合移植进行回顾性研究，以核实移植后30天内AGPN的发生情况。我们发现，112例患者（15.8%）在肾移植后30天内出现移植后AGPN。老年患者（P = 0.005）和输尿管支架置入患者（P = 0.06）的发生率更高。大肠埃希菌是尿培养中最常见的微生物（32%）。输尿管支架（相对风险= 1.7；置信区间[CI]，1.1 - 2.5；P = 0.018）是AGPN的主要危险因素，年龄较大（RR = 1.02；CI 1.01 - 1.04；P = 0.001）、住院时间（RR = 1.01；CI，1.01 - 1.02；P < 0.001）以及抗胸腺细胞球蛋白（ATG）诱导治疗（RR = 1.6；CI，1.022 - 2.561；P = 0.04）也是危险因素。移植后30天内发生肾盂肾炎的患者，其长期移植肾和患者生存率显著降低（分别为OR 1.43；95% CI，0.95 - 2.16；P = 0.024和OR 1.77；95% CI，1.12 - 2.80；P = 0.006）。因此，移植后30天内的急性肾盂肾炎与较低的长期移植肾和患者生存率相关。
