Factors associated with transplantectomy in patients hospitalized with renal allograft pyelonephritis: a single-center observational study

Introduction: chronic kidney disease remains a major healthcare challenge, particularly in cases of endstage renal failure, where kidney transplantation is the most effective treatment. However, post-transplant complications – such as transplant pyelonephritis – significantly compromise graft function and potentially result graft loss. This study aimed to identify predictors of transplantectomy in patients hospitalized with allograft pyelonephritis and to develop a predictive model for assessing the risk of adverse outcomes.Materials and Methods: a retrospective single-center study was conducted, analyzing 501 cases of pyelonephritis in transplanted kidneys in adult patients hospitalized between January 1, 2018, and June 30, 2024. Demographic, medical history, laboratory, and imaging data were collected, and patient outcomes were assessed. Logistic regression was applied to identify predictors of transplantectomy. The predictive performance of developed model was evaluated using receiver operating characteristic (ROC) analysis.Results: transplantectomy was required in 5.8% of patients. Key predictors of graft removal included nonfunctioning graft (adds ratio, OR=13.647; p< 0.001), presence of urosepsis (OR=4.804; p=0.014), and the need for renal replacement therapy (OR=12.884; p=0.026). COnversely, the use of triple immunosuppressive therapy was identified as a protective factor (OR=0,140; p=0.003). The developed predictive model demonstrated strong associations between clinical factors and the risk transplantectomy, showing a reasonably good fit to the observed data (AUC=0.951; 95% CI: 0.920.98).Discussion and Conclusion: the most significant predictors of transplantectomy were a nonfunctioning graft and systemic infectious complications such as urosepsis. The use of triple immunosuppressive therapy showed a protective effect, underscoring the importance of optimizing immunosuppressive regimens in transplant recipients. These findings provide a foundation for developing strategies to identify patients at high risk of graft loss early and to improve treatment outcomes. However, further validation through multicenter prospective studies is warranted to strengthen and generalize these results.