Acute graft pyelonephritis following renal transplantation Abstract: Background. Urinary tract infection is the most common form of bacterial infection encountered in a renal transplant recipient. Studies explaining the long-term consequences of acute graft pyelonephritis (AGPN) are few. Methods. A total of 1022 consecutive renal allograft recipients were studied retrospectively over a period of 10 years for evidence of AGPN. These patients were classi¢ed into two groups according to the presence or absence of at least one AGPN episode. Only culture-proven infections were included in the study. Result. Of the 1022 renal transplant recipients, 169 patients (16.5%) developed AGPN. In the multivariate analysis with stepwise logistic regression, significant associations were observed between AGPN and placement of ureteric stent (odds ratio [OR] 5 4.6), urological malformations of native kidney (OR 5 2.1), cytomegalovirus (CMV) disease (OR 5 2.0), mycophenolate mofetil (MMF)-based regimen (OR 5 1.9), and acute rejection episodes (OR 5 1.5). However, age440 years, female gender, induction therapy, anti-CD3 treatment, and hyperglycemia did not show such an association. In comparison with the non-AGPN group, these patients had a lower graft and patient survival (though it did not attain statistical significance). In the multivariate analysis using the Cox model for the entire study population, AGPN did not independently contribute to poor graft or patient survival. Conclusion. AGPN in the renal transplant setting is an ominous event, as these patients are also more prone to develop bacteremia, acute rejection, and CMVdisease, which could then lead to poor graft and patient survival. Its association with MMF needs further clari¢cation. Rejection and infections are the two major determinants of long-term graft and patient survival following a successful renal transplantation. The incidence of rejection has been steadily decreasing over the years with many centers expe- riencing acute rejections in less than 15% (1).The principal reason for this reduction is the advent of more potent Key words: graft pyelonephritis; renal transplant; acute rejection; CMV disease; mycophenolate mofetil N.S. Kamath G.T. John N. Neelakantan M.G. Kirubakaran C.K. Jacob Received 25 August 2005, revised 25 November, accepted for publication 5 December 2005 Copyright & Blackwell Munksgaard 2006 Transplant Infectious Disease . ISSN 1398 -2273 Transpl Infect Dis 2006: 8: 140^147 All rights reserved Authors’af¢liations: N.S. Kamath 1 , G.T. John 1 , N. Neelakantan 2 , M.G. Kirubakaran 1 , C.K. Jacob 1 1 Department of Nephrology 2 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India Correspondence to: Chakko K. Jacob, MD, DM, MNAMS Department of Nephrology Christian Medical College Vellore,Tamil Nadu 632004 India Tel: 1 91- 416 -2222053 Fax: 1 91- 416 -2232103 e-mail: ckjacob@hotmail.com 140