■急性移植肾盂肾炎(AGPN)是肾移植(KTs)中相对常见的并发症;然而,对同种异体移植功能的影响,诊断标准,和风险因素没有很好地确定。
在2011年1月1日至2018年12月31日期间对所有连续成年KT进行回顾性分析(随访于2019年12月31日结束),以检查移植后第一年的AGPN诊断(经磁共振成像[MRI]证实)与移植物结局之间的关系。
■在939个连续的KT中(捐献者≥60岁时约为50%),我们确定了130次MRI证实的AGPN发作,与复发性和多药耐药细菌性尿路感染(UTI)相关(p<0.005)。输尿管狭窄是与AGPN相关的唯一危险因素(OR2.9[95%CI,1.6-5.2])。使用AGPN的KT在第一年的同种异体移植功能降低(非AGPN的ΔeGFR6mL/min/1.73m2[-2-15]与-0.2[-6.5-8.5]在AGPN中,p<0.001),来自标准或老年捐赠者的KT具有相似和负面的特征。然而,只有AGPN和供体<60岁的KT显示死亡审查移植物存活率降低(p=0.015);该亚组中的大多数接受了抗胸腺细胞球蛋白(ATG)诱导(40.4%vs.17.7%),他们的MRI表现为多焦AGPN模式(73.9%vs.56.7%)或脓肿(28.3%与11.7%)。早期(KT后<3个月)或晚期(3-12个月)AGPN之间的死亡审查移植物存活率没有差异,孤立/复发形式,或多药耐药病原体的类型。线性回归证实了多焦点模式的独立作用,脓肿,ATG感应,和捐赠者的年龄在第一年的eGFR。
■AGPN,受到多焦点呈现的影响,ATG感应,供体年龄,和脓肿,影响肾功能,并显着影响供体<60岁的KT的同种异体移植存活率。
UNASSIGNED: Acute 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.
UNASSIGNED: Retrospective 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.
UNASSIGNED: Among 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.
UNASSIGNED: AGPN, influenced by multifocal presentation, ATG induction, donor age, and abscedation, affects kidney function and significantly impacts allograft survival in KTs with donors <60 years.