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

Frontiers in Immunology

Clarisse Kerleau¹  Jacques Dantal²  Magali Giral²  Sophie Brouard²  Florent Le Borgne³  Margaux Pacaud⁴  Luc Colas⁴ 

[1] CHU Nantes, Nantes Université, Service de néphrologie – immunologie clinique, Nantes, France;Centre d’Investigation Clinique en Biothérapie, Centre de ressources biologiques (CRB), Nantes, France;IDBC-A2COM, Pacé, France;INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France;Labex IGO, Nantes, France;Université de Tours, INSERM UMR 1246-SPHERE, Nantes, France;

关键词: acute pyelonephritis;    kidney allograft;    graft failure;    patient survival;    long-term outcome;   

DOI  :  10.3389/fimmu.2022.824425

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown