Mathews T, Pushkar D, Kaul A, Bhaduaria D, Prasad N, Patel M, Behera M, Yachha M, Kushwaha R, Srivastava A
Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Transpl Immunol. 2022 Dec;75:101657. doi: 10.1016/j.trim.2022.101657. Epub 2022 Jul 3.
Acute graft pyelonephritis (AGPN) is thought to affect graft and patient survival among renal transplant recipients. The objective was to compare outcomes among early AGPN (< 6 months from transplant) versus late AGPN (> 6 months from transplant).
This retrospective study analyzed 150 patients with AGPN dividing them into early and late AGPN from 2008 to 2016. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots.
55.3% (n = 83) had early AGPN and 44.7% (n = 67) had late AGPN. In early AGPN group, 13.3% had CMV disease on follow up compared to 3% in late AGPN group (p < 0.05). 26.5% had history of prolonged Foley's catheterization (> 5 days), 38.6% had prolonged DJ stent in-situ (> 2 weeks) following transplant surgery in the early AGPN compared to 7.5% and 19.4% respectively in the late AGPN group (p < 0.05). Recurrent GPN was more common in the late AGPN group - (35.8% versus 18.1%). Presence of renal abscess was predictive of graft loss in Univariate analysis (HR-6.12, p < 0.004). There was decreased death censored graft survival in the early AGPN group (p-0.035) with no significant difference in patient survival among the two groups.
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.
急性移植肾盂肾炎（AGPN）被认为会影响肾移植受者的移植肾和患者生存。目的是比较早期AGPN（移植后<6个月）与晚期AGPN（移植后>6个月）的结局。
这项回顾性研究分析了150例AGPN患者，将他们在2008年至2016年间分为早期和晚期AGPN。使用逻辑回归分析比较移植肾丢失和死亡率的预测因素。使用Kaplan-Meier生存曲线分析移植肾生存和患者生存情况。
55.3%（n = 83）为早期AGPN，44.7%（n = 67）为晚期AGPN。在早期AGPN组中，13.3%在随访时有巨细胞病毒疾病，而晚期AGPN组为3%（p < 0.05）。26.5%有长期留置Foley导管史（>5天），早期AGPN组在移植手术后38.6%有长期留置DJ支架原位（>2周），而晚期AGPN组分别为7.5%和19.4%（p < 0.05）。复发性GPN在晚期AGPN组更常见（35.8%对18.1%）。在单因素分析中，肾脓肿的存在是移植肾丢失的预测因素（风险比-6.12，p < 0.004）。早期AGPN组的死亡校正移植肾生存率降低（p = 0.035），两组患者生存率无显著差异。
早期AGPN的发生对肾移植受者的长期移植肾生存有显著影响，对患者生存无显著影响。本研究强调了预防肾移植受者尿路感染的至关重要性。
