Urodynamic Risk Factors for Recurrent Febrile Graft Pyelonephritis in Kidney Transplant Recipients: A Retrospective Study

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms Pub Date : 2025-09-13 DOI:10.1111/luts.70031

Jun Kamei, Ei-ichiro Takaoka, Takehiro Ohyama, Sho Nishida, Daiji Watanabe, Aya Niimi, Yuta Yamada, Toru Sugihara, Satoshi Ando, Haruki Kume, Daiki Iwami, Tetsuya Fujimura

{"title":"Urodynamic Risk Factors for Recurrent Febrile Graft Pyelonephritis in Kidney Transplant Recipients: A Retrospective Study","authors":"Jun Kamei, Ei-ichiro Takaoka, Takehiro Ohyama, Sho Nishida, Daiji Watanabe, Aya Niimi, Yuta Yamada, Toru Sugihara, Satoshi Ando, Haruki Kume, Daiki Iwami, Tetsuya Fujimura","doi":"10.1111/luts.70031","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>We aimed to assess lower urinary tract function and morphological changes in kidney transplant recipients with a history of graft pyelonephritis and investigate the association between specific types of lower urinary tract dysfunction and the risk of recurrent graft pyelonephritis.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively reviewed the medical records of kidney transplant recipients hospitalized for febrile graft pyelonephritis more than 1 year after transplantation between April 2019 and October 2023. Patients underwent cystography and urodynamic studies after infection control and were followed up for at least 12 months. They were classified based on urodynamic findings, and recurrence-free survival was analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-four patients were included. Vesicoureteral reflux of the grafted kidney was observed in 20 (83.3%) patients. Detrusor overactivity, detrusor underactivity, and low-compliance bladders were diagnosed in 8 (33.3%), 12 (50.0%), and 7 (29.2%) patients, respectively. Based on urodynamic findings, treatment and bladder management were modified in 20 patients. During a median follow-up of 33 months, seven patients developed recurrent graft pyelonephritis. Detrusor overactivity remained an independent risk factor for recurrent graft pyelonephritis (odds ratio, 21.4; <i>p =</i> 0.04). Patients with detrusor overactivity or underactivity but not low-compliance bladder had significantly shorter recurrence-free survival compared with those without these dysfunctions (<i>p</i> = 0.017, 0.038, and 0.38, respectively).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Persistent lower urinary tract dysfunction, particularly detrusor overactivity, is a significant risk factor for recurrent graft pyelonephritis. Comprehensive evaluation of vesicoureteral reflux and lower urinary tract function via urodynamic studies is important to improve posttransplant outcomes in patients with a history of graft pyelonephritis.</p>\n </section>\n </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 5","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70031","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"LUTS: Lower Urinary Tract Symptoms","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/luts.70031","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

We aimed to assess lower urinary tract function and morphological changes in kidney transplant recipients with a history of graft pyelonephritis and investigate the association between specific types of lower urinary tract dysfunction and the risk of recurrent graft pyelonephritis.

Methods

We retrospectively reviewed the medical records of kidney transplant recipients hospitalized for febrile graft pyelonephritis more than 1 year after transplantation between April 2019 and October 2023. Patients underwent cystography and urodynamic studies after infection control and were followed up for at least 12 months. They were classified based on urodynamic findings, and recurrence-free survival was analyzed.

Results

Twenty-four patients were included. Vesicoureteral reflux of the grafted kidney was observed in 20 (83.3%) patients. Detrusor overactivity, detrusor underactivity, and low-compliance bladders were diagnosed in 8 (33.3%), 12 (50.0%), and 7 (29.2%) patients, respectively. Based on urodynamic findings, treatment and bladder management were modified in 20 patients. During a median follow-up of 33 months, seven patients developed recurrent graft pyelonephritis. Detrusor overactivity remained an independent risk factor for recurrent graft pyelonephritis (odds ratio, 21.4; p = 0.04). Patients with detrusor overactivity or underactivity but not low-compliance bladder had significantly shorter recurrence-free survival compared with those without these dysfunctions (p = 0.017, 0.038, and 0.38, respectively).

Conclusions

Persistent lower urinary tract dysfunction, particularly detrusor overactivity, is a significant risk factor for recurrent graft pyelonephritis. Comprehensive evaluation of vesicoureteral reflux and lower urinary tract function via urodynamic studies is important to improve posttransplant outcomes in patients with a history of graft pyelonephritis.

Abstract Image

查看原文本刊更多论文

肾移植受者发热性肾盂肾炎复发的尿动力学危险因素：一项回顾性研究

目的评估有移植物肾盂肾炎病史的肾移植受者的下尿路功能和形态变化，探讨特定类型的下尿路功能障碍与移植物肾盂肾炎复发风险之间的关系。方法回顾性分析2019年4月至2023年10月肾移植术后1年以上因发热性移植物肾盂肾炎住院的患者病历。患者在感染控制后接受膀胱造影和尿动力学检查，并随访至少12个月。根据尿动力学结果对患者进行分类，并分析无复发生存率。结果共纳入24例患者。20例（83.3%）患者出现移植肾膀胱输尿管反流。分别有8例（33.3%）、12例（50.0%）和7例（29.2%）患者被诊断为逼尿肌过度活动、逼尿肌活动不足和低依从性膀胱。根据尿动力学的发现，对20例患者的治疗和膀胱管理进行了改进。在中位随访33个月期间，7例患者复发移植物肾盂肾炎。逼尿肌过度活动仍然是移植物肾盂肾炎复发的独立危险因素（优势比为21.4;p = 0.04）。膀胱逼尿肌过度活动或活动不足但非低顺应性的患者与无这些功能障碍的患者相比，无复发生存期明显较短（p分别= 0.017、0.038和0.38）。结论持续性下尿路功能障碍，尤其是逼尿肌过度活动是移植物肾盂肾炎复发的重要危险因素。通过尿动力学研究综合评价膀胱输尿管反流和下尿路功能对于改善移植物肾盂肾炎病史患者移植后的预后非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.