Treatment of Biopsy-Proven Pyelonephritis of the Transplanted Kidney is Associated with Better Graft Outcomes
University of Wisconsin, Madison, WI
Meeting: 2021 American Transplant Congress
Abstract number: 163
Keywords: Kidney, Outcome, Urinalysis
Topic: Clinical Science » Infectious Disease » Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Information
Session Name: Infections in Kidney Recipients
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 6, 2021
Session Time: 6:00pm-7:00pm
Presentation Time: 6:25pm-6:30pm
Location: Virtual
*Purpose: The outcomes of treatment of pyelonephritis of the transplant kidney is not known.
*Methods: From 01/1998 to 12/2019, 101 patients were found to have pyelonephritis (PN) on the transplant kidney biopsy. Patients were divided into two groups: those who had positive urine for urinary tract infection (WBC ≥10/hpf with the presence of bacteria on dipstick with squamous cells < 5) (UA+PN) and those who had negative urine for urinary tract infection (UA-PN). The groups were further subdivided into patients who received antibiotics and those who did not.
*Results: The mean age at transplant was 44 ± 13 years. The mean time from transplant to diagnosis of pyelonephritis on transplant kidney biopsy was 3.3 ± 4 years. The most common reason for the biopsy in this cohort was elevated creatinine (86%). 38 (37.6%) of the patients with pyelonephritis on biopsy had a negative UA. UA+PN group had significant history of previous UTIs (p=0.004) and had more clinical symptoms of UTI (p=0.01) as compared to UA-PN group. Out of 63 patients in the UA+PN group, 55 (87.3%) received antibiotics. Only 11 of the UA-PN patients (29%) received antibiotics. In the UA+PN group, E. coli was the most common microorganism (62%), followed by klebsiella pneumonia (19%). No organisms were isolated in the UA-PN group. The use of antibiotics in both the UA+PN group (p=0.03) and UA-PN group (p=0.02) was associated with improved death censored graft survival. On multivariate analysis, being white (HR=0.31, p=0.003, 95%Cl 0.142 to 0.68) and the use of antibiotics (HR=0.22, p=0.0002, 95%Cl 0.10 to 0.48) were associated with better graft survival, but evidence of infection in urine did not reach statistical significance (HR=0.52, p=0.09, 95%Cl 0.25 to 1.10). An analysis limited to the 75 patients who had no symptoms of UTI at the time of biopsy produced similar findings, including the benefits of treating biopsy proven PN with antibiotics.
*Conclusions: Treatment of this finding with antibiotics regardless of evidence of infection in the urine is associated with improved graft survival. Future studies are needed to better define the risk factors and treatment strategies for this condition.
To cite this abstract in AMA style:
Aziz F, Saddler C, Alstott J, Swanson K, Parajuli S, Garg N, Djamali A, Mandelbrot D. Treatment of Biopsy-Proven Pyelonephritis of the Transplanted Kidney is Associated with Better Graft Outcomes [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/treatment-of-biopsy-proven-pyelonephritis-of-the-transplanted-kidney-is-associated-with-better-graft-outcomes/. Accessed May 9, 2025.« Back to 2021 American Transplant Congress