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Association Between Episodes of Acute Pyelonephritis and Interstitial Fibrosis and Tubular Atrophy (Ifta) without or with Inflammation (Ifi) on 1-Year Protocol Biopsy Following Kidney Transplantation

Body: INTRODUCTION AND AIMS: It has been observed that IFTA and IFI are associated with worse kidney allograft function and survival. The aim of this study was to determine the association between acute pyelonephritis (AP) and IFTA or IFI on a 1- year protocol biopsies. METHODS: Total of 115 adult recipients following kidney and combined kidney transplantation were included and followed for 1 year. Immunosuppression therapy consisted of daclizumab (86%) and anthythymocyte globulin (12%) in induction, tacrolimus (58%), cyclosporine (39%), sirolimus (0, 9%), mycophenolate mophetil (100%) and steroids (59%) in maintenance therapy. Diagnosis of AP was based on positive urine culture, 10 leucocytes/hpf of urine sediment and raised C-reactive protein. Protocol biopsies were classified according to Banff classification. RESULTS: Incidence of AP was 43% within first year post transplant. Recipients maintained on steroids had significantly more AP, compared to rapid steroid withdrawal group (RSW) (62% vs. 31%, respectively ; p=0.007). Recipients with AP had significantly more AR compared to non AP group (60% vs. 39%, respectively ; p=0.011). Total of 71 kidney allograft biopsies were analyzed at 1 year. IFTA was present in 76% of all biopsies and of those, 29% had IFTA and 71% had IFI. In group without AR, 38% had IFTA, 38% had IFI and 28% had normal findings. IFTA was more frequent in AP group (27% vs. 15%), though it did not attain statistical significance (p=0.481). In group without AR, IFTA was more frequent in AP group (62% vs. 23%) while IFI was evenly distributed (37% vs. 38%) (p=0.08). IFTA was associated with significantly lower glomerular filtration rate (GFR) at 1 year compared to IFI or normal biopsy (50 ml/min, 62, 8 ml/min, 71, 5 ml/min, respectively ; p=0.003). CONCLUSIONS: AP was independent predictor of lower GFR at 1 year post transplant. IFTA was more frequent in those with AP, though this did not reach statistical significance. IFI was not associated with AP.

Histology; Graft function; Infection; Inflammation

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