Reccurent acute graft pyelonephritis (AGPN) with vesicoureteral reflux (GVUR) can have a deleterious impact on graft outcome. The objective of this study was to evaluate success rate and predictives factors of recurrence of AGPN after endoscopic injection of polydimethylsiloxane (EIP).

Forty-eight patients (51 graft) with recurrent AGPN associated to radiological GVUR treated by EIP between 2000 and 2012 were retrospectively included. GVUR were classified in low grade (LG) for I and II radiological type and high grade (HG) for types III to V.

Treatment failure was defined as recurrence of AGPN. Free graft pyelonephritis (FGP) survival was calculated by Kaplan-Meier method. Duration of dialysis, presence of native kidneys VUR, number of pretreatment AGPN, time to onset after transplantation, grade, time to GVUR management, experience of the surgeon, voiding dysfunction and pretreatment creatininemia were evaluated as predictors of failure using uni-multivariate Cox regression analyse.

Twenty-four patients were included in LG group (4 grade I & 20 grade II) and 27 patients in HG group (respectively 21, 5 & 1 grades III to V). Median age was 50 years (IQR: 37-63) and median follow-up was 25 months (IQR:10-37). The 2 groups were comparable for all studied variables (p>0.05). No obstruction was observed. Median (range) creatininemia before and 3 months after correction were respectively 1.5 (IQR 1.3-2.0) mg/dL and 1.4 (1.2-1.9) mg/dL (P=0.043).

Overall success rate was 70.6 % (n=36). The FGP rates at 1 and 3 years of EIP were 70.6% and 64.2 %, with no difference between the two groups (p=0.549). Recurrence (n=15) occurred at 5 months (IQR:3-9) regardless of grade (p=0.131), with 75% of persistent reflux. Three independent prognostic factors were identified: lack of residual diuresis before transplantation (p=0.014), voiding dysfunction (p=0.001) and the limited experience of surgeon (p=0.006). For patients treated by a senior surgeon (n=32), the absence and presence of 1 then 2 of other risk factors were associated respectively with FGP rates at 2 years of 100% , 51.9 % and 33.3 % (p<0.001).

EIP is a safe and effective first-line method to decrease recurrent AGPN for patient with GVUR. The consideration of failure factors would improve the results of endoscopic treatment and may be involved in the decision to offer second injection or open surgical correction.

CITATION INFORMATION: Nison L, Hazzan M, Puech P, Bouye S. Endoscopic Polydimethylsiloxane Injection in Prevention of Recurrent Graft Pyelonephritis for Transplanted Kidney with Vesicoureteral Reflux. Am J Transplant. 2016;16 (suppl 3).

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