title: Acute Graft Pyelonephritis Occurring up to 30 Days After Kidney Transplantation: Epidemiology, Risk Factors, and Survival.
abstract: 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.
authors.affiliation: 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. Electronic address: leonardo.kroth@pucrs.br.
authors.forename: L V
authors.initials: LV
authors.lastname: Kroth
authors.affiliation: 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.
authors.forename: F F
authors.initials: FF
authors.lastname: Barreiro
authors.affiliation: 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.
authors.forename: D
authors.initials: D
authors.lastname: Saitovitch
authors.affiliation: 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.
authors.forename: M A
authors.initials: MA
authors.lastname: Traesel
authors.affiliation: 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.
authors.forename: D O L
authors.initials: DO
authors.lastname: d'Avila
authors.affiliation: 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.
authors.forename: C E
authors.initials: CE
authors.lastname: Poli-de-Figueiredo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011704:Pyelonephritis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D014513:Ureter / Q000601:surgery; D014552:Urinary Tract Infections / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents