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

Pacaud, Margaux; Colas, Luc; Kerleau, Clarisse; Borgne, Françoise Le; Giral, Magali; Brouard, Sophie; Dantal, Jacques

doi:10.3389/fimmu.2022.824425

Cited by 3 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent studies that evaluated the impact of AGPN on eGFR showed negative effects on graft survival and eGFR, but in populations with a limited number of old recipients/donors [recipients and donor age 52.6 [40.15–60.7] and 53 [41–62] in Maanaoui et al ( 6 ), and 51.0 ± 14.1 and 52.1 ± 16.4 in Pacaud et al ( 7 )]. Additionally, neither of them routinely prescribed radiological confirmation for an AGPN diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In the past few years, this pathological process has been considered a relatively "benign" condition (22,23). More recently, an increasing number of papers have highlighted the potential role of AGPN in determining reduced graft function and kidney survival (6,7,(24)(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

“…For example, diagnostic criteria for AGPN included only suggestive clinical symptoms and typical laboratory findings without radiological confirmation ( 5 ), and differences between early or late occurrences after transplant are a matter of debate ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Different profiles of acute graft pyelonephritis among kidney recipients from standard or elderly donors

Tarragoni,

Congiu,

Mella

et al. 2024

Front. Med.

View full text Add to dashboard Cite

BackgroundAcute graft pyelonephritis (AGPN) is a relatively common complication in kidney transplants (KTs); however, the effects on allograft function, diagnostic criteria, and risk factors are not well established.MethodsRetrospective analysis of all consecutive adult KTs was performed between 01 January 2011 and 31 December 2018 (follow-up ended on 31 December 2019) to examine the association between the diagnosis of AGPN (confirmed with magnetic resonance imaging [MRI]) during the first post-transplantation year and graft outcomes.ResultsAmong the 939 consecutive KTs (≈50% with donors ≥60 years), we identified 130 MRI-confirmed AGPN episodes, with a documented association with recurrent and multidrug-resistant bacterial urinary tract infections (UTIs) (p < 0.005). Ureteral stenosis was the only risk factor associated with AGPN (OR 2.9 [95% CI, 1.6 to 5.2]). KTs with AGPN had a decreased allograft function at the first year (ΔeGFR 6 mL/min/1.73 m2 [−2–15] in non-AGPN vs. −0.2 [−6.5–8.5] in AGPN, p < 0.001), with similar and negative profiles in KTs from standard or elderly donors. However, only KTs with AGPN and a donor <60 years showed reduced death-censored graft survival (p = 0.015); most of this subgroup received anti-thymocyte globulin (ATG) induction (40.4% vs. 17.7%), and their MRI presented either a multifocal AGPN pattern (73.9% vs. 56.7%) or abscedation (28.3% vs. 11.7%). No difference was noted in death-censored graft survival between early (<3 months post-KT) or late (3–12 months) AGPN, solitary/recurrent forms, or types of multidrug-resistant pathogens. Linear regression confirmed the independent role of multifocal pattern, abscedation, ATG induction, and donor age on the eGFR at the first year.ConclusionAGPN, influenced by multifocal presentation, ATG induction, donor age, and abscedation, affects kidney function and significantly impacts allograft survival in KTs with donors <60 years.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Different profiles of acute graft pyelonephritis among kidney recipients from standard or elderly donors

Tarragoni,

Congiu,

Mella

et al. 2024

Front. Med.

View full text Add to dashboard Cite

show abstract

“…In the ICU setting, acute graft pyelonephritis is the leading cause of around 20% of sepsis cases, and AKI occurrence is typically linked to the development of septic shock [9]. It is an independent risk factor for estimated glomerular filtration rate (eGFR) decline (−2.29 mL/min/1.73 m 2 [95% CI: −3.23 to −1.35]) and graft loss at 1 year (HR: 1.66 [95% CI: 1.05-2.64], although late (i.e., more than 6 months following transplantation) recurrences did not exert a cumulative detrimental effect on allograft survival or on acute rejection frequency [36][37][38]. Although several risk factors for UTIs are widely reported, including donor-related, recipient-related (female gender, advanced age, pre-transplant anatomic abnormalities, diabetes) and transplant-related factors (overimmunosuppression, prolonged placement of ureteral stent), a growing body of evidence highlighted the relevance of the urinary microbiome in the setting of UTIs recurrence and AKI episodes in KTRs [34].…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

Acute Kidney Injury in Kidney Transplant Patients in Intensive Care Unit: From Pathogenesis to Clinical Management

Fiorentino,

Bagagli,

Deleonardis

et al. 2023

Biomedicines

View full text Add to dashboard Cite

Kidney transplantation is the first-choice treatment for end-stage renal disease (ESRD). Kidney transplant recipients (KTRs) are at higher risk of experiencing a life-threatening event requiring intensive care unit (ICU) admission, mainly in the late post-transplant period (more than 6 months after transplantation). Urosepsis and bloodstream infections account for almost half of ICU admissions in this population; in addition, potential side effects related to immunosuppressive treatment should be accounted for cytotoxic and ischemic changes induced by calcineurin inhibitor (CNI), sirolimus/CNI-induced thrombotic microangiopathy and posterior reversible encephalopathy syndrome. Throughout the ICU stay, Acute Kidney Injury (AKI) incidence is common and ranges from 10% to 80%, and up to 40% will require renal replacement therapy. In-hospital mortality can reach 30% and correlates with acute illness severity and admission diagnosis. Graft survival is subordinated to baseline estimated glomerular filtration rate (eGFR), clinical presentation, disease severity and potential drug nephrotoxicity. The present review aims to define the impact of AKI events on short- and long-term outcomes in KTRs, focusing on the epidemiologic data regarding AKI incidence in this subpopulation; the pathophysiological mechanisms underlying AKI development and potential AKI biomarkers in kidney transplantation, graft and patients’ outcomes; the current diagnostic work up and management of AKI; and the modulation of immunosuppression in ICU-admitted KTRs.

show abstract

Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study

Hosseinpour,

Pezeshgi,

Mahdiabadi

et al. 2023

BMC Nephrol

View full text Add to dashboard Cite

Background A kidney recipient's urinary tract infection (UTI) can result in infectious problems and be a risk factor for less successful transplant outcomes. UTI risk factors are still controversial. The present study aimed to investigate the prevalence of UTI and its association with risk factors in kidney recipients. Method Twenty-six papers published between 2005 and 2022 were retrieved using keywords and searching Medlib, ScienceDirect, PubMed, and other databases. If possible, the pooled prevalence of UTI in kidney recipients and odds ratio (OR) with a 95% confidence interval for each risk factor were calculated. The data were analyzed using the random effects model in R and Stata 14. Results The total sample size was 72,600, with an average age of 48.7 years. The pooled prevalence of UTI was 35% (95% CI, 30–40%). The estimated risk factors for UTI were female (OR = 3.13; 95%CI: 2.35—4.17), older age (OR = 1.03; 95%CI: 1—1.05), history of UTI (OR = 1.31; 95%CI) CI: 1.05—1.63), receiving a kidney from a deceased donor (OR = 1.59; 95%CI: 1.23—2.35), long-term use of an indwelling catheter (OR = 3.03; 95%CI: 1.59—6.59), a ureteral stent (OR = 1.54; 95%CI: 1.16—2.06), diabetes (OR = 1.17; 95%CI: 0.97—1.41), hypertension (OR = 1.6; 95%CI: 1.26—2.28), acute rejection process (OR = 2.22; 95%CI: 1.45—3.4), and abnormal urinary tract anatomy (OR = 2.87; 95%CI 1.44—5.74). Conclusion This meta-analysis revealed that UTIs are a significant problem in kidney recipients. Factors such as female sex, old age, history of UTIs, deceased donor, long-term use of an indwelling catheter, diabetes, acute rejection process, use of ureteral stent, abnormal urinary tract anatomy, and hypertension were related to an increased risk of UTIs in kidney recipients.

show abstract

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

Cited by 3 publications

References 28 publications

Different profiles of acute graft pyelonephritis among kidney recipients from standard or elderly donors

Different profiles of acute graft pyelonephritis among kidney recipients from standard or elderly donors

Acute Kidney Injury in Kidney Transplant Patients in Intensive Care Unit: From Pathogenesis to Clinical Management

Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study

Contact Info

Product

Resources

About