TY - JOUR
T1 - Outcomes of asymptomatic histologic pyelonephritis of kidney transplant
AU - Budhiraja, Pooja
AU - Butterfield, Richard
AU - Gea-Banacloche, Juan
AU - Swaminathan, Sundararaman
AU - Smith, Maxwell L.
AU - Khamash, Hassan A.
AU - Me, Hay Me
AU - Kodali, Lavanya
AU - Mour, Girish K.
AU - Nair, Sumi
AU - Misra, Suman
AU - Heilman, Raymond L.
N1 - Publisher Copyright:
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft biopsy. Histologic Pyelonephritis was defined as neutrophil cast or neutrophilic tubulitis, interstitial infiltrates with predominant neutrophils, and no evidence of rejection or glomerulonephritis on biopsy. Methods: The study included 123 kidney transplant recipients, of whom 95 underwent protocol biopsies, and 28 had biopsies for elevated creatinine within the first 2 years of a kidney transplant. Results: The mean age of the cohort was 55.3 years, with 52% females and 78% deceased donor transplants. The risk factors for asymptomatic histologic pyelonephritis were recipient female sex (OR 1.89, 1.3–2.7, diabetes mellitus (OR 2.479, 1.687–3.645), and deceased donation (OR 1.69, 1.098–2.63). The incidence of asymptomatic pyelonephritis on protocol biopsy was 1.7%, with 52% having positive urine cultures and Escherichia coli being the most common bacteria. Subjects with asymptomatic pyelonephritis had inferior graft survival compared to the matched cohort HR 1.88 (1.06–3.35), p =.0281. In addition, of these 123 subjects, 68 (55%) subsequently developed pyelonephritis, and 34 subjects had pyelonephritis within 6 months after this episode. Subjects with recurrent infections exhibited lower survival HR 2.86 (1.36–6.02) and a trend toward higher rejection risk. Conclusion: Asymptomatic histologic pyelonephritis can occur in kidney transplant recipients and is associated with inferior graft survival.
AB - Background: Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft biopsy. Histologic Pyelonephritis was defined as neutrophil cast or neutrophilic tubulitis, interstitial infiltrates with predominant neutrophils, and no evidence of rejection or glomerulonephritis on biopsy. Methods: The study included 123 kidney transplant recipients, of whom 95 underwent protocol biopsies, and 28 had biopsies for elevated creatinine within the first 2 years of a kidney transplant. Results: The mean age of the cohort was 55.3 years, with 52% females and 78% deceased donor transplants. The risk factors for asymptomatic histologic pyelonephritis were recipient female sex (OR 1.89, 1.3–2.7, diabetes mellitus (OR 2.479, 1.687–3.645), and deceased donation (OR 1.69, 1.098–2.63). The incidence of asymptomatic pyelonephritis on protocol biopsy was 1.7%, with 52% having positive urine cultures and Escherichia coli being the most common bacteria. Subjects with asymptomatic pyelonephritis had inferior graft survival compared to the matched cohort HR 1.88 (1.06–3.35), p =.0281. In addition, of these 123 subjects, 68 (55%) subsequently developed pyelonephritis, and 34 subjects had pyelonephritis within 6 months after this episode. Subjects with recurrent infections exhibited lower survival HR 2.86 (1.36–6.02) and a trend toward higher rejection risk. Conclusion: Asymptomatic histologic pyelonephritis can occur in kidney transplant recipients and is associated with inferior graft survival.
KW - asymptomatic
KW - graft survival
KW - kidney transplant
KW - pyelonephritis
KW - urinary tract infections
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U2 - 10.1111/ctr.15125
DO - 10.1111/ctr.15125
M3 - Article
C2 - 37705388
AN - SCOPUS:85170675538
SN - 0902-0063
VL - 37
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 12
M1 - e15125
ER -