Treating pyelonephritis of the transplanted kidney even without evidence of infection may improve graft survival, investigators reported at the virtual American Transplant Congress 2021.
Of 101 patients (mean age at transplant: 44 years) with biopsy-proven pyelonephritis, 63 (63%) had a positive result on urinalysis and 38 (38%) had a negative result. A positive urinalysis reflected a white blood cell count of 10 or greater per high powered field, bacteria on dipstick, and less than 5 squamous cells.
Significantly more patients in the positive urinalysis group had history of urinary tract infections (UTIs) and multiple clinical symptoms of UTI compared with the negative urinalysis group, Fahad Aziz, MD, and colleagues from the University of Wisconsin in Madison reported. In the positive group, Escherichia coli was found in 62% and Klebsiella pneumonia in 19%. No organisms were isolated from the negative group.
Antibiotics were administered to 87.3% of the positive group and 29% of the negative group. On multivariate analysis, the use of antibiotics itself was significantly associated with a 78% improvement in death-censored graft survival, Dr Aziz’s team reported. White race was significantly associated with a 69% lower risk of death-censored graft loss compared with non-White race. Infection in urine was not a significant factor.
Treatment of biopsy-proven pyelonephritis with antibiotics regardless of evidence of infection in the urine is associated with improved graft survival, Dr Aziz’s team concluded.
The mean time from transplant to diagnosis of pyelonephritis on biopsy was 3.3 years. For 86% of patients, biopsy was ordered due to elevated creatinine (86%).
Aziz F, Saddler C, Alstott J, et al. Treatment of biopsy-proven pyelonephritis of the transplanted kidney is associated with better graft outcomes. Am J Transplant. 2021;21 (suppl 3). Presented at the virtual American Transplant Congress 2021, June 5-9, 2021. Abstract 163.