Transpl Infect Dis. 2006;8:140-147


Acute graft pyelonephritis (AGPN) increases the risk of bacteremia, acute rejection, and cytomegalovirus (CMV) disease, but it does not independently contribute to poor graft or patient survival, researchers in India report.

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Chakko K. Jacob, MD, of Christian Medical College, Vellore, Tamil Nadu, and his colleagues studied 1,022 renal allograft re-cipients, of whom 169 (16.5%) experienced AGPN. Ureteric stent placement was associated with a 4.6 times higher risk of AGPN and CMV disease, and the presence of a native kidney with urological malformations and a mycophenolate mofetil (MMF)-based immu-nosuppressive regimen each was associated with a twofold higher risk.


AGPN led to bacteremia in 28.4% of the AGPN group versus 4% of the non-AGPN group, the investigators found. Acute rejection episodes occurred in 49.1% of the AGPN group compared with 38.5% of the non-AGPN group. Additionally, 21.3% of the AGPN group and 11.4% in the non-AGPN group had CMV disease at presentation.


Of the AGPN patients with CMV disease, the latter manifested following an AGPN episode in 67.7% of patients, a finding that supports the view that UTI reactivates CMV, the investigators

stated. CMV disease preceded AGPN in 14.7% and occurred at the same time in 17.6%.


“AGPN in the post-transplant period creates an unfavorable milieu because of its association with the rejection process or by reactivating CMV,” the authors concluded. The risk of rejection is always a factor but can be managed with prophylactic care. They added that the associated risk of AGPN with MMF “is probably a consequence of depressed humoral immunity in these patients.”