Factors Predisposing to Urinary Tract Infections in Adult Kidney Allograft Recipients with Lower Urinary Tract Reconstruction

Abstract

Objective Urinary bladder augmentation or urinary diversion may be necessary for successful kidney transplantation in cases of serious urinary tract dysfunction. Patients with reconstructions of the urinary collecting system show noninferior graft survival, although urinary tract infections (UTI) may threaten kidney and recipient survivals. Herein we sought to identify risk factors for serious UTIs in cases of urinary collecting system reconstructions and to evaluate kidney survival and function. Patients and Methods This prospective, case-controled study included 24 kidney allograft recipients with urinary tract reconstructions who were engrafted from 1999 to 2008. As controls we selected recipients of standard kidney transplants who were matched (1:3) for sex, age, donor type, procedure date, and immunosuppressive regimen. Results At posttransplantation 33.6 ± 28 months follow-up, kidney allograft survival was 83% among the reconstructed and 97% among the control groups ( P = NS). Kidney allograft function at 3 months in the reconstruction group showed estimated glomerular filtration rate (eGFR) calculated by the Cockcroft-Gault (C-G) equation of 70.4 ± 20.8 vs 78.8 ± 19.2 mL/1.73 m 2 in controls ( P = .39), and at the end of follow-up, 66.3 ± 18.1 vs 77.1 ± 18.9 mL/1.73 m 2, respectively ( P = .26). Urinary tract reconstruction patients experienced UTI in 91.7% of cases (n = 22) vs 45.6% in controls (n = 31; P < .0001). A necessity for in-hospital treatment was observed in 67% vs 28% of cases ( P < .001). Urosepsis occurred in 4 study patients and 4 controls ( P = NS). We observed an increased risk for serious UTI and a trend to diminished graft function (odds ratio [OR] = 1.6 per 10 ml/min of eGFr C-G; 95% confidence interval (CI) 0.97–2.77; P = .055; and OR = 14.7 per 1 mg/dL of serum creatinine; 95% CI 0.61–352.3; P = .097). Another predictor for UTI was cytomegalovirus disease (CMV). Conclusion Kidney recipients requiring urinary tract reconstructions additionally benefit from obtaining the best quality allografts and CMV prophylaxis.