Systematic Kidney Biopsies After Acute Allograft Pyelonephritis

Cartery, C.; Guilbeau‐Frugier, Céline; Esposito, Laure; Sallusto, Fédérico; Guitard, Joëlle; Cardeau-Desangles, Isabelle; Cointault, Olivier; Gamé, X.; Rostaing, Lionel; Kamar, Nassim

doi:10.6002/ect.2012.0216

Cited by 7 publications

(6 citation statements)

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“…9,10 Persistent inflammation after the HAGPN diagnosis was previously reported in 28 patients who had repeat biopsies, and it was associated with poor outcomes 1 year later. 28 Overall, our results and those of previous studies are consistent with the general consensus that any allograft inflammation, irrespective of its cause, is detrimental to the allograft. 29,30 This study is limited by the relatively small number of HAGPN cases, which precluded complete multivariate analysis of all factors associated with HAGPN in single variable analysis.…”

Section: Discussionsupporting

confidence: 92%

“…Some evidence also supports a synergistic effect between bacteriuria and rejection on allograft function 9,10 . Persistent inflammation after the HAGPN diagnosis was previously reported in 28 patients who had repeat biopsies, and it was associated with poor outcomes 1 year later 28 . Overall, our results and those of previous studies are consistent with the general consensus that any allograft inflammation, irrespective of its cause, is detrimental to the allograft 29,30 …”

Section: Discussionsupporting

confidence: 91%

“…Of the nine patients with diagnosed UTIs, six patients had symptoms of UTI prior to kidney biopsy. Thirty‐nine (85%) of patients were treated with antibiotics for median of 14 days 7–28 after the diagnosis of HAGPN.…”

Section: Resultsmentioning

confidence: 99%

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Histologic acute graft pyelonephritis after kidney transplantation: Incidence, clinical characteristics, risk factors, and association with graft loss

Powers

Hellinger

Cortese

et al. 2022

Transplant Infectious Dis

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Background: Histologic acute graft pyelonephritis (HAGPN) after kidney transplantation (KT) has been assessed less frequently than urinary tract infections (UTIs) or clinical acute graft pyelonephritis. Risk factors for HAGPN, its association with graft loss, and measures that might prevent it are not known. Methods:We performed a retrospective review of HAGPN cases identified from KT occurring between January 2008 and December 2017 at our institution. We compared the HAGPN cases to a randomly selected control group of KTs to identify risk factors using univariate and multivariate Cox regression models. The association between HAGPN and graft loss was also assessed, similarly. Results: HAGPN was identified in 46 of 1391 patients (cumulative incidence, 5% [95% CI, 3%-7%]) undergoing KT at a single center from January 2008 through December 2017 (median time to diagnosis, 241 days after KT; interquartile range, 122-755 days). Indications for biopsy were follow-up of treated rejection (n = 20 [43%]), KT protocol biopsy (n = 19 [41%]), and acute kidney injury (n = 7 [15%]). Histologic rejection, UTI, and asymptomatic bacteriuria (ASB) were present in 23 (50%), 9 (20%), and 16 (35%). Multivariate Cox proportional hazards models comparing KT recipients with or without HAGPN (n = 46 and n = 138, respectively) showed that HAGPN was associated with urologic complication by day 30, delayed graft function, previous UTI or ASB, and a history of rejection. In the univariate and multivariate analyses, HAGPN was associated with an increased risk of graft loss. Conclusion: HAGPN is an infrequent, unanticipated, and clinically significant complication of KT.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

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Histologic acute graft pyelonephritis after kidney transplantation: Incidence, clinical characteristics, risk factors, and association with graft loss

Powers

Hellinger

Cortese

et al. 2022

Transplant Infectious Dis

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“…In the same line, Cartery and al performed systematic graft biopsies one month after an episode of AGPN and compared them to protocol kidney biopsy at one year that did not present AGPN. The authors observed more frequent tubulitis histologic patterns after AGPN all the more so eGFR did not return to baseline ( 26 ), which makes an echo to our data where AGPN were associated with a lower eGFR without altering significantly eGFR decay. The authors also observed an increased CNI through level in the AGPN group ( 26 ).…”

Section: Discussionsupporting

confidence: 78%

“…The authors observed more frequent tubulitis histologic patterns after AGPN all the more so eGFR did not return to baseline ( 26 ), which makes an echo to our data where AGPN were associated with a lower eGFR without altering significantly eGFR decay. The authors also observed an increased CNI through level in the AGPN group ( 26 ). Altogether, those data argued that recurrent AGPN after kidney transplantation were associated with a poorer graft function but also a poorer patient survival all the more so the first recurrent episode occurred early with in the first six months post-transplant.…”

Section: Discussionsupporting

confidence: 78%

Impact of Late and Recurrent Acute Graft Pyelonephritis on Long-Term Kidney Graft Outcomes

et al. 2022

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BackgroundWhile Urinary tract infections are the most common infections in kidney transplant recipients, the impact of late acute graft pyelonephritis (AGPN) on graft outcomes remains unknown. Our study was performed to more precisely evaluate the long-term impact of AGPN.MethodsWe included 9052 kidney and combined kidney-pancreas recipients who underwent transplantation between 2008 and 2018 from a French multicenter cohort. The relationships between AGPN and patient and graft survival were analyzed with a time-dependent multivariate Cox model.ResultsThe cumulative incidence of AGPN was 20.9%. A first episode of early AGPN is associated with a non-significant increase in the risk of graft failure (hazard ratio [HR], 1.27; 95% confidence interval [95% CI], 0.90 to 1.79). Though, cumulative number of AGPN episodes (HR = 1.51; 95% CI, 0.89 to 2.57 for two episodes and HR = 2.08; 95% CI, 1.17 to 3.69 for three or more episodes) is associated with an increased risk of graft failure. In contrast, when the first episode of AGPN occurred late (i.e., 6 months post transplantation), the risk of graft failure is significantly increased (HR = 2.25; 95% CI, 1.65 to 3.07), and this risk remains relatively stable with the recurrence of late AGPN episodes. The onset of late AGPN were also associated with a higher risk of patient death. ConclusionThis analysis shows that late AGPN and recurrent AGPN are both risk factors for a poor long-term graft outcome and mortality. Late AGPN should not be considered benign infections in post-transplantation follow-up.

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Rejection Challenges: Diagnosis and Management

Lang

Riazy

Blydt‐Hansen

2021

Challenges in Pediatric Kidney Transplantation

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Systematic Kidney Biopsies After Acute Allograft Pyelonephritis

Abstract: Objectives: Scarce data exist regarding the effect of acute graft pyelonephritis on kidney histology after a kidney transplant. This study sought to assess the kidney histology at 1 month, and kidney function at 1 year, after acute graft pyelonephritis in kidney transplant patients.

Cited by 7 publications

References 20 publications

Histologic acute graft pyelonephritis after kidney transplantation: Incidence, clinical characteristics, risk factors, and association with graft loss

Histologic acute graft pyelonephritis after kidney transplantation: Incidence, clinical characteristics, risk factors, and association with graft loss

Impact of Late and Recurrent Acute Graft Pyelonephritis on Long-Term Kidney Graft Outcomes

Rejection Challenges: Diagnosis and Management

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