Post-transplant Urinary Tract Infections Research Articles

A Retrospective View of Post Renal Transplant Urinary Tract Infections: An Experience of A UK Transplant Centre

Urinary tract infections (UTIs) are prevalent post renal transplant complication. These infections are most common in renal transplant recipient’s contrary to their incidence in general healthy population as shown by previous studies. Though the frequencies of occurrences are different in renal transplant patients. There is general lack of consensus on the risk factors associated with development of UTIs in renal transplant patients as well as effects posed by them and occurrence of mortality in patient group. This retrospective cohort study investigated and included adults’ patients who were operated for renal transplant in a single transplant center in UK from Jan 2014 to December 2023. The number of patients were 604 with two hundred and fifty-nine developed one or more UTIs in 42 months follow-up period. Significant risk factors for post-transplant UTIs were advanced age, female gender, reflux kidney disease, use of azathioprine and cadaveric donor. UTIs did not increase risk for renal graft loss, but were associated with increased mortality (3.5 odds ratio, 95% confidence interval 1.68–7.23). We conclude UTIs may be associated with an increased mortality risk in renal transplant recipients. Prevention of UTIs in high-risk renal transplant patients or those with recurrent UTIs may possibly decrease post-transplant mortality.

Acidic Urine pH and Clinical Outcome of Lower Urinary Tract Infection in Kidney Transplant Recipients Treated with Ciprofloxacin and Fosfomycin.

Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant recipients (KTRs) with UTI episodes by Escherichia coli (N = 115) and Klebsiella pneumoniae (N = 69). Initial urine pH, antimicrobial therapy, and clinical and microbiological outcomes, and one- and six-month follow-up were assessed. Fosfomycin was prescribed in 88 (76.5%) E. coli and 46 (66.7%) K. pneumoniae UTI episodes in the total cohort. When the urine pH ≤ 6, fosfomycin was prescribed in 60 (52.2%) E. coli and 29 (42.0%) K. pneumoniae. Initial urine pH ≤ 6 in E. coli UTI was associated with symptomatic episodes (8/60 vs. 0/55, p = 0.04) at one-month follow-up, with a similar trend in those patients receiving fosfomycin (7/47 vs. 0/41, p = 0.09). Acidic urine pH was not associated with microbiological or clinical cure in K. pneumoniae UTI. At pH 5, the ciprofloxacin MIC90 increased from 8 to >8 mg/L in E. coli and from 4 to >8 mg/L in K. pneumoniae. At pH 5, the fosfomycin MIC90 decreased from 8 to 4 mg/L in E. coli and from 512 to 128 mg/L in K. pneumoniae. Acidic urine is not associated with the microbiological efficacy of fosfomycin and ciprofloxacin in KTRs with UTI, but it is associated with symptomatic UTI episodes at one-month follow-up in E. coli episodes.

Urinary Tract Infection 1 Year After Kidney Transplant: Effect on Kidney Transplant Outcomes.

Transplant is the gold standard treatment for end-stage renal disease, and yet infectious complications frequently arise in kidney recipients in the context of immunosuppression therapy, with urinary tract infection being the most common. We aimed to assess the prevalence of posttransplant urinary tract infections in kidney transplant recipients and assess the effects on kidney allograft and overall patient outcomes. We performed a retrospective analysis of data from State University of New York Upstate University Hospital from January 2016 to November 2022 to assess transplant outcomes in patients who underwent a kidney transplant at our center and met the inclusion criteria. There were 507 renal allograft recipients who met our inclusion criteria and were assessed for the incidence of urinary tract infection within the first year after transplant. Urinary tract infection was recurrent in 113 transplant recipients (55.6%) within the first year, and 118 (58.1%) were on prophylactic antibiotics at urinary tract infection diagnosis. We observed no relation between recurrence of urinary tract infection and use of prophylactic antibiotics (P = .21). Overall allograft survival rate was 92.1% in the urinary tract infection group and 96.7% in the group without urinary tract infection, which was significantly different (P = .02). Urinary tract infection significantly affected allograft survival (hazard ratio, 3.51; 95% CI, 1.49-8.23; P = .004). Overall patient survival rates were 86.7% and 91.4% in the groups with and without urinary tract infection, respectively (P = .08). We determined that allograft survival was significantly greater in the group without urinary tract infection versus the urinary tract infection group. We found no relation between urinary tract infection recurrence and prophylactic antibiotics. We also found that overall patient survival was not significantly different in the group with urinary tract infection versus the group without urinary tract infection.

MP53-03 UROLOGIC RISK FACTORS FOR URINARY TRACT INFECTION AND ALLOGRAFT FAILURE IN PEDIATRIC RENAL TRANSPLANTATION

You have accessJournal of UrologyCME1 Apr 2023MP53-03 UROLOGIC RISK FACTORS FOR URINARY TRACT INFECTION AND ALLOGRAFT FAILURE IN PEDIATRIC RENAL TRANSPLANTATION Vinicius Seidel, Matthew Buell, Kai Wen Cheng, Cayde Ritchie, Adam Fisher, David Chamberlin, and Joshua Chamberlin Vinicius SeidelVinicius Seidel More articles by this author , Matthew BuellMatthew Buell More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Adam FisherAdam Fisher More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) causes morbidity in children with end stage renal disease (ESRD) and may lead to allograft failure. Appropriate urologic evaluation is important before and after renal transplantation. The purpose of this study is to identify risk factors for UTI and allograft failure in children with ESRD. METHODS: A retrospective review of all pediatric renal transplant patients at a single transplant center from 2013 to 2022 was performed. Inclusion criteria were patients less than 18 years of age with ESRD who underwent their first renal transplantation. Patients with less than 6 months follow-up were excluded. The primary endpoints were UTI occurrence and allograft failure. Allograft failure was defined as rejection with return to dialysis. Statistical comparisons were made using the Chi Square test and the Wilcoxon signed rank test. RESULTS: 79 children underwent renal transplantation with a median follow-up time of 56 months (6-112 months). Etiologies for renal failure were identified as renal in 60 (76%) patients and bladder in 19 (24%) patients. Renal failure in patients with congenital anomaly of kidney and urinary tract (CAKUT) was seen in 33% of renal etiologies and 100% of bladder etiologies. Overall, the UTI rate was lower pre-transplant (8%) compared to post-transplant (28%) (p=0.002). Pre-transplant bladder etiology for renal failure had a higher UTI rate when compared to the renal etiology (26% vs 2%, p=0.002). Post-transplant there was no difference in UTI rate between bladder etiology and renal etiology (37% vs 25%, p=0.32). 27% of patients had pre-transplant native kidney vesicoureteral reflux (VUR) and 11% had transplant kidney VUR. Children with native kidney VUR had a higher UTI rate pre-transplant (48% vs. 21%, p<0.05). Children with transplant kidney VUR had a higher UTI rate than those without transplant VUR (67% vs. 23%, p<0.05). Patients with poor bladder compliance and capacity on urodynamics when medically and surgically optimized, did not have increased post-transplant UTI rates. 14 (17.7%) patients developed allograft rejection. Etiology and onset time of initial renal failure, number of UTI, CAKUT, and VUR were not associated with allograft rejection. CONCLUSIONS: Pediatric ESRD patients with pre-transplant native kidney VUR and renal transplant VUR are at increased risk for UTI and should be treated. Unsafe bladders when optimized may safely undergo transplantation. Renal allograft failure was not associated with etiology, onset time of initial renal failure, number of UTI, CAKUT, and VUR. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e712 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinicius Seidel More articles by this author Matthew Buell More articles by this author Kai Wen Cheng More articles by this author Cayde Ritchie More articles by this author Adam Fisher More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...

Diabetes Mellitus as a Predictive Factor for Urinary Tract Infection for Patients Treated with Kidney Transplantation.

Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients who underwent KT for end-stage kidney disease (ESKD) from January 2008 to December 2021 at Gifu University Hospital. UTI was defined as the existence of bacterial and/or fungal infection in urine with ≥105 colony-forming units/mL, with or without urinary and/or systemic symptoms of UTI. Patients were divided into two groups: those with UTI after KT (UTI group) and those without UTI (non-UTI group). The primary endpoint of this study was the relationship between covariates and UTI after KT. Results: Two hundred and forty patients with ESKD received KT at Gifu University Hospital. Thirty-four participants developed UTI after surgery, and the most common pathogen was Escherichia coli. At the end of the follow-up, graft loss was observed in six patients (2.5%), independent of UTI episodes. In the multivariate analysis, diabetes mellitus (DM) was statistically associated with post-transplant UTI in kidney transplant recipients. Conclusions: Preoperative serum glucose control in patients with DM may have a crucial role in preventing UTI and preserving renal function after KT.

POS-098 MILKY URINE IN RENAL ALLOGRAFT RECIPIENT - CAN NATIVE KIDNEY BE THE CULPRIT ?

Milky urine can be caused due to both infectious and non-infectious causes. We present a case of 48 years old male, 6 years post kidney transplant who presented as milky urine and was initially managed with diethylcarbamazine (DEC) and intravenous antibiotics. As he was not responding he was evaluated further to be diagnosed as candiduria arising from left native kidney. He had a quick response to left native nephrectomy and liposomal amphotericin. 48 years old male patient, who was 6 years post kidney transplant (Basic disease - diabetic nephropathy), with normal graft function on triple drug immunosupressants ( tacrolimus, mycophenolate and pednisolone) presented with complaint of milky white urine during morning hours only. He was afebrile and had no symptoms of burning or pain during micturition. His urine examination showed few pus cells and was hazy in appearance. Urine cytology for malignant cells showed no evidence of atypical cells. Urine for fat globules was negative though triglycerides were 470 mg/dl and urine was labelled as chylous. His ultrasound was suggestive of mild pelvicalyceal fullness of transplant kidney which was confirmed by CT scan. His leucocyte counts, calcium and phosphorus were within normal range. His early morning smear sample showed no evidence of wuchereria bancrofti microfilariae. He was emperically started on DEC 6mg/kg. After 5 days his urine culture yielded growth of klebsiella species and was treated with injectable ceftriaxone-sulbactum combination as per culture sensitivity report for 2 weeks. He was asymptomatic till the time he was on antibiotics and again developed episodes of milky urine. He also passed some fleshy material in urine was sent for histology. He was posted for cystoscopy which revealed whitish efflux from left native uretric orifice, which was sent for cytology and left uretric catheterization was done. Both the tissue and fluid showed colonies of budding yeast cell and pseudohyphae suggestive of candida species. Considering the non functional status of left native kidney (by imaging and history of anuria pre transplant), left laproscopic native nephrectomy was done and in view of post transplant immunosupressed state, intravenous liposomal amphotericin was given for 2 weeks. He had a quick response to the treatment. In post transplant urinary tract infections, we should also focus on native kidneys especially in diabetic population. There are many case reports of recurrent urinary tract infections post transplant due to native pyelonephritis requiring native nephrectomy.

Early post-transplant urinary tract infection epidemiology and risk factor

Background and objectives: Renal Transplantation became the most successful management for end stage renal failure; postoperative urinary tract infection is the most common complication. The aim is to evaluate the outcome and risk factors of posttransplant urinary tract infection. Methods: This is a prospective study for renal transplant patients between 2018-2019 in Hawler/ Rizgary and Paky hospital. Patients, who underwent renal transplant, with 1 year follow up. Variable risk factors assessment done including chronic renal failure etiology, preoperative dialysis duration, operation time, length of drain and Foley’s catheter, type of immune suppressive therapy used, time and numbers of hospitalization associated with posttransplant urinary tract infection were examined, the relation between the risk factors and urinary tract infection was evaluated. Results: Total of 63 patients was involved, 12 had a total of 24 urinary tract infection attacks; the most common isolated microorganisms were E-coli and Klepsiella. The infection frequently appeared during the first 120 days postoperatively. Among the analyzed variables, there was no significant difference. Assessing all the variables, number of hospitalization after discharge were significantly more frequent in the 12 patients with infection attacks, although 31 patients out of 63 had hospitalized, as compared to patients without infection, but this difference was statistically insignificant. Conclusions: The most significant period for infection in renal transplanted patients after 1 year follow up is the first 4 months postoperatively. Patients who were admitted to hospital for different reasons and those who had preoperative history of urinary tract infection, have a higher risk.

Gut microbiome dysbiosis in the setting of solid organ transplantation: What we have gleaned from human and animal studies

The human gut microbiome refers to all of the microorganisms present throughout the length of the gastrointestinal tract. Gut flora influence host metabolic and immune processes in myriad ways. They also play an important role in maturation and modulation of the immune system. Dysbiosis or a pathologic alteration in gut flora has been implicated in a number of diseases ranging from metabolic, autoimmune and degenerative. Whether dysbiosis has similar implications in organ transplant has been the focus of a number of pre-clinical and clinical studies. Researchers have observed significant microbiome changes after solid organ transplantation in humans that have been associated with clinical outcomes such as post-transplant urinary tract infections and diarrhea. In this article, we will discuss the available data regarding pathologic alterations in gut microbiome (dysbiosis) in solid organ transplant recipients as well as some of challenges in this field. We will also discuss animal studies focusing on mouse models of transplantation that shed light on the underlying mechanisms that explain these findings.

Urological Complications in Kidney Transplant Recipients: Analysis of the Risk Factors and Impact on Transplant Outcomes in the Era of “Extended Criteria Donors”

Urological complications (UC) following kidney transplantation (KT) are associated with increased morbidity. The aim of this study is to evaluate the risk factors for UC in the era of “extended criteria donors” (ECD) and their impact on patient and graft survivals. A retrospective monocentric study of all patients undergoing KT from 2010 to 2019 with a follow-up ≥30 days was performed. Out of 459 patients (males: 296 (64.5%); age: 57 (19–77) years) enrolled, 228 (49.7%) received ECD organs, moreover, 166 (67.2%) grafts had a cold ischemia time ≥10 h. UCs were reported in 32 (7%) patients. In 21 (65.6%) cases UC occurred within 3 months post-KT and 24 (5.2%) were associated with early urinary tract infection (UTI). The overall 5 year patient and graft survival rates were 96.5% and 90.6%, respectively. UC decreased graft survival (UC-group: 75.0% vs. noUC-group: 91.8%, p &lt; 0.001), especially if associated with early UTI (UC-group: 71.4% vs. noUC-group: 77.8%, p &lt; 0.001). At multivariate analysis, early UTI after KT (OR: 9.975, 95%-IC: 2.934–33.909, p &lt; 0.001) and delayed graft function (DGF) (OR: 3.844, 95%-IC: 1.328–11.131, p: 0.013) were significant risk factors for UC, while ECD graft did not increase the risk of post-transplant UC. ECD grafts are not associated with UC. DGF and early UTI post-KT increase the risks of UC and reduce graft survival in the long-term. Therefore, aggressive management of early post-transplant UTI and strategies to reduce DGF incidence, such as machine preservation, are essential to prevent UC after KT.

Patient Survival After Kidney Transplantation: Important Role of Graft-sustaining Factors as Determined by Predictive Modeling Using Random Survival Forest Analysis

Identification of the relevant factors for death can improve patient's individual risk assessment and decision making. A well-documented patient cohort (n = 892) in a renal transplant program with protocol biopsies was used to establish multivariable models for risk assessment at 3 and 12 months posttransplantation by random survival forest analysis. Patients transplanted between 2000 and 2007 were observed for up to 11 years. Loss to follow-up was negligible (n = 15). A total of 2251 protocol biopsies and 1214 biopsies for cause were performed. All rejections and clinical borderline rejections in protocol biopsies were treated. Ten-year patient survival was 78%, with inferior survival of patients with graft loss. Using all pre- and posttransplant variables until 3 and 12 months (n = 65), the obtained models showed good performance to predict death (concordance index: 0.77-0.78). Validation with a separate cohort of patients (n = 349) showed a concordance index of 0.76 and good discrimination of risks by the models, despite substantial differences in clinical variables. Random survival forest analysis produced robust models over a wide range of parameter settings. Besides well-established risk factors like age, cardiovascular disease, type 2 diabetes, and graft function, posttransplant urinary tract infection and rejection treatment were important factors. Urinary tract infection and rejection treatment were not specifically associated with death due to infection or malignancy but correlated strongly with inferior graft function and graft loss. The established models indicate the important areas that need special attention in the care of renal transplant patients, particularly modifiable factors like graft rejection and urinary tract infection.

Five compelling UTI questions after kidney transplant.

Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX). To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review. Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant. The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI's importance for graft function and patient outcome.

Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study.

Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.

Graft Survival in Patients With Lower Urinary Tract Dysfunction.

We aimed to the determine urinary tract infection and graft survival rates in pediatric renal transplant recipients with lower urinary tract dysfunction with particular focus on neurogenic bladder, posterior urethral valve, and vesicoureteral reflux nephropathy. Patients were grouped according to primary diseases as those with and without lower urinary tract dysfunction. Urinary tract infections during year 1 posttransplant were investigated. Estimated glomerular filtration rate was calculated using Schwartz formula. Our study investigated 133 kidney transplant recipients. Lower urinary tract dysfunction was found in 58 patients (43.6%): 25 with posterior urethral valve, 24 with vesicoureteral reflux nephropathy, and 9 with neurogenic bladder. Rates of posttransplant urinary tract infection were higher in patients with lower urinary tract dysfunction than in those without during both the first 6 months posttransplant (24.6% vs 10.8%; P = .037) and between posttransplant months 6 and 12 (24.6% vs 8.2%; P = .01). Patients with neurogenic bladder had the highest rate of urinary tract infections, and their estimated glomerular filtrations rates were lower compared with patients with posterior urethral valve and vesicoureteral reflux nephropathy at month 6 and years 1, 2, and 5 posttransplant (P < .001). The 5-year graft survival rates of patients without lower urinary tract dysfunction and those with vesicoureteral reflux nephropathy were similar (51.3% vs 51.6%; P = .891). Graft survival rates of patients with posterior urethral valve and vesicoureteral reflux nephropathy were similar to those shown in patients without lower urinary system dysfunction; however, patients with neurogenic bladder had worse graft survival and urinary tract infection rates.

Risk factors for death in kidney transplant patients: analysis from a large protocol biopsy registry.

Identification and quantification of the relevant factors for death can improve patients' individual risk assessment and decision-making. We used a well-documented patient cohort (n = 892) in a renal transplant programme with protocol biopsies to establish multivariable Cox models for risk assessment at 3 and 12 months post-transplantation. Patients transplanted between 2000 and 2007 were observed up to 11 years (total observation 5227 patient-years; median 5.9 years). Loss to follow-up was negligible (n = 15). A total of 2251 protocol biopsies and 1214 biopsies for cause were performed. All rejections and clinical borderline rejections in protocol biopsies were treated. Overall 10-year patient survival was 78%, with inferior survival of patients with graft loss and superior survival of patients with living-donor transplantation. Eight factors were common in the models at 3 and 12 months, including age, pre-transplant heart failure and a score of cardiovascular disease and type 2 diabetes, post-transplant urinary tract infection, treatment of rejection, new-onset heart failure, coronary events and malignancies. Additional variables of the model at 3 months included deceased donor transplantation, transplant lymphocele, BK virus nephropathy and severe infections. Graft function and graft loss were significant factors of the model at 12 months. Internal validation and validation with a separate cohort of patients (n = 349) demonstrated good discrimination of the models. The identified factors indicate the important areas that need special attention in the pre- and post-transplant care of renal transplant patients. On the basis of these models, we provide nomograms as a tool to weigh individual risks that may contribute to decreased survival.

Posttransplant urinary tract infections and surgical site infections among renal transplant recipients in a transplant unit in Sri Lanka

Aim: Kidney transplant (KT) recipients are at higher risks of infections due to the chronic disease conditions, the surgical procedure and immunosuppressive therapy following transplantation. We aimed to assess the incidence and the microbiology of urinary tract infections (UTIs) and surgical site infections (SSIs) in KT recipients at the transplant unit in Kandy Teaching Hospital, Sri Lanka. Methods: A prospective, descriptive study was carried out in patients undergoing KT for 6 months postoperatively. A urine full report and culture were carried out before transplantation and on days 1, 3, 7 and monthly for 6 months posttransplantation. Urine specimens yielding growth of ≥105 CFU/ml were considered significant. In addition, patients were screened preoperatively for Staphylococcus aureus colonization by multi-site swabbing. The surgical sites were inspected daily for SSI. Results: Thirty-nine patients were recruited in the study. Two patients (5.1%) had preoperative UTI and 4 (10.3%) developed UTI within 6 months. Majority of post-KT UTI (75.0%) occurred in the 1st month. UTI was commonly due to coliforms (50.0%) while S. aureus and Pseudomonas spp. accounted 25% each. All screened patients were colonized with S. aureus and majority (62.9%) were methicillin-resistant S. aureus. Only 3 (8.6%) KT recipients had SSIs. Conclusion: The incidence of UTI in KT recipients within the first 6 months was 10.3%, and majority occurred in the 1st month. Patients, who were treated for UTI preoperatively, did not develop post-KT UTI. Coliforms were the most common organism. Although there was high S. aureus colonization index, the incidence of SSI in post-KT recipients was low.

Posttransplant Urinary Tract Infection Rates and Graft Outcome in Kidney Transplantation for End-Stage Renal Disease Due to Reflux Nephropathy Versus Chronic Glomerulonephritis.

The goal of this study was to evaluate posttransplant urinary tract infection (UTI) rates and graft outcome in kidney transplantation for end-stage renal disease (ESRD) due to vesicoureteral reflux (VUR)-related reflux nephropathy (RN) versus chronic glomerulonephritis (CGN). A total of 62 patients with ESRD who underwent kidney transplantation for VUR-related RN (VUR-RN group, n= 31; mean ± standard deviation age, 34.1 ± 6.0 years; 58.1% female) or CGN (CGN group, n= 31; mean age, 34.2 ± 6.8 years; 71.0% male) at our unit between January 1996 and January 2011 were included in this retrospective study. Baseline recipient and donor characteristics, renal replacement therapy, posttransplant data on serum creatinine levels, graft outcome, and UTIs were recorded. Posttransplant UTIs and graft outcome were compared between the VUR-RN and CGN groups, as well as between patients with and without pretransplant nephrectomy in the VUR-RN group. The frequency of overall (72 vs 18 of 90; P= .05) UTI episodes was significantly higher in the VUR-RN group than in the CGN group; Escherichia coli (64.2%) was the most common pathogen. The VUR-RN and CGN groups were similar in terms of 1-year (100.0% for each), 5-year (95.8% vs 96.8%), and 10-year (82.0% vs 96.8%) graft survival. VUR-RN patients with and without nephrectomy were similar in terms of 1-year (100.0% for each), 5-year (91.7% vs 85.7%), and 10-year (81.5% vs 85.7%) graft survival. Our findings indicate kidney transplantation is a safe and effective option in ESRD patients with RN secondary to VUR. It resulted in high 1-year, 5-year, and 10-year graft survival rates.

2316 DOES THE USE OF URETERAL STENTS IN RENAL TRANSPLANT ALLOGRAFTS INCREASE THE RISK OF MULTI-DRUG RESISTANT URINARY TRACT INFECTIONS OR DECREASE LONG TERM FUNCTION OF THE ALLOGRAFT?

INTRODUCTION AND OBJECTIVES: Post renal transplant infectious complications are largely due to urinary tract infections (UTIs). We determined whether the use of a stent increased the risk of developing a multi-drug resistant urinary tract infection in renal transplant patients or affected long term function of the allograft. METHODS: We retrospectively analyzed our transplant cases from 2006-2009 (N 172). We divided our cohort into stented or nonstented. We analyzed the cases for development of first post transplant UTI. We further analyzed these positive urine cultures for the presence of multidrug resistance. Of the patients that developed infections we looked at gender, race, ethnicity, preoperative GU anatomic anomalies, and postoperative complications and whether these variables had any significance in the development of postoperative multidrug resistant UTI. Stents were removed at 3 weeks posttransplant. Comparisons of variables between the two cohorts were evaluated using the SAS statistical software. T-test and Chi square were utilized to compare the 2 cohorts with p 0.05 considered significant. RESULTS: Our data analysis found that there was no significant difference in the development of a multidrug resistant UTI in stented versus non-stented patients. Factors having significance in posttransplant multidrug resistant UTI development were female gender (p 0.02) and postoperative complications (p 0.001). Patients with prior GU abnormalities had an increased incidence of postoperative UTI however this did not reach statistical significance. There was no significant difference by race or age. The graft function was the same whether patients had a stent or no stent. CONCLUSIONS: Our data shows that the risk of development of a multidrug resistant UTI was not increased by the use of a stent at the time of transplant. The risk of multidrug resistant UTI is increased if the patient is female, has had prior GU anomalies, or had postoperative complications.

Early Post-Transplant Urinary Tract Infections; Impact on Graft and Patient Survival

Introduction: Sepsis is the commonest cause of morbidity and mortality following solid organ transplantation. Urinary Tract Infections (UTI) including graft pyelonephritis is the commonest cause for sepsis related graft and patient loss following renal transplantation. Significant pyuria (pus cells >10 per high power field in a standard urinanalysis) is a common finding in End Stage Renal Disease (ESRD). The causative factors include low urine volumes, bladder stasis, underlying renal parenchymal disease, chronic haemodialysis, and latent or overt UTI. Its presence often confounds the decision and timing of renal transplantation. In this study we looked at the possible association of pre-operative pyuria with the incidence of post-transplant UTI, other identifiable risk factors for post-transplant UTI and their overall impact on graft and patient survival. Methodology: Three hundred and four (304) consecutive kidney transplants performed by the Colombo University Transplant Unit, Sri Lanka between January 2007 and March 2011 were prospectively analysed. All were living donor transplants and the mean follow up was 12(2-36) months. All those with significant pyuria were investigated extensively prior to transplantation to exclude a treatable cause (UTI, stones, tuberculosis etc.). If a treatable cause was identified, it was treated completely before proceeding to transplantation. All transplant ureters were routinely stented and routine standardized antibiotic prophylaxis was given perioperatively. Results: A total of 62 (62/304, 20%) early UTI were encountered in this cohort which included 15(5%) cases of graft pyelonephritis. In a multivariate analysis, diabetes mellitus in the recipient (p=0.9), female gender (p=0.7), acute rejection in the first month (p=0.3) and pre-operative pyuria (p=0.6) were not significantly associated with early UTI. 49/62 (79%) of the UTIs were successfully treated with complete resolution while 6 (10%) were associated with Primary Graft Failure (PGF) and 5 (8%) with sepsis related deaths. One with PGF also died during follow up while 1 was re-transplanted after complete resolution of the UTI. Four patients with PGF remain on haemodialysis awaiting re-transplantation. Conclusion: The incidence of post-transplant UTI is high in our experience. Likewise, the incidence of significant pyuria in the local population awaiting renal transplantation in this resource limited setting has also been shown to be high. However, this study showed that once a treatable cause was excluded or treated, pre-operative pyuria did not have any significant correlation with post-transplant UTI. The quest for minimizing UTI and thereby the related graft and patient loss continues.

Urinary Tract Infections in Renal Transplant Recipients

Introduction Urinary tract infections (UTIs) are most common infections in renal transplant recipients and are considered a potential risk factor for poorer graft outcomes. Aim To evaluate incidence, clinical manifestations, microbiology, risk factors for UTIs, and the influence of UTIs on long-term renal graft function. Patients and methods We analyzed urine cultures with reference to clinical data of patients who received a renal transplantation from January to December 2009 with a 12-month follow-up. Results The 1170 urine cultures were correlated with clinical data from 89 renal transplant recipients, including 58.4% males and on overall mean age of 48 ± 14 years. The 151 episodes in 49 patients consisted of asymptomatic bacteriuria (65%, n = 98); lower UTIs (13%, n = 19); and upper UTIs (22%, n = 34), as well as five cases of bacteremia. Nearly 48% of UTIs were diagnosed during the first month posttransplantation. The most frequently isolated uropathogens were Enterococcus faecium (33%, n = 24) and Escherichia coli (31%, n = 23). Beginning from the second month, most frequently found bacterium in urine cultures was E coli (65% n = 51). Risk factors for posttransplant UTIs were female gender and a history of an acute rejection episode and/or a cytomegalovirus (CMV) infection. All patients with vesicoureteral reflux of strictures at the ureterovesical junction suffered recurrent UTIs ( n = 7). The evolution of renal graft function did not differ significantly between patients with versus without UTIs. Conclusions UTIs a frequent problem after kidney transplantation most commonly exist as asymptomatic bacteriuria. E coli and E faecium are ther predominant pathogens. Exposure to intensified immunosuppression due to acute rejection episodes or CMV infections represents a risk factor for UTIs. Vesicoureteral reflux or strictures at the ureterovesical junction are risk factors for recurrent UTIs. UTIs did not impair 1-year graft function.

Risk Factors for Urinary Tract Infection After Renal Transplantation and its Impact on Graft Function in Children and Young Adults

Urinary tract infection will develop in 40% of children who undergo renal transplantation. Post-transplant urinary tract infection is associated with earlier graft loss in adults. However, the impact on graft function in the pediatric population is less well-known. Additionally the risk factors for post-transplant urinary tract infection in children have not been well elucidated. The purpose of this study was to assess the relationship between pre-transplant and post-transplant urinary tract infections on graft outcome, and the risk factors for post-transplant urinary tract infection. A total of 87 patients underwent renal transplantation between July 2001 and July 2006. Patient demographics, cause of renal failure, graft outcome, and presence of pre-transplant and post-transplant urinary tract infections were recorded. Graft outcome was based on last creatinine and nephrological assessment. Median followup was 3.12 years. Of the patients 15% had pre-transplant and 32% had post-transplant urinary tract infections. Good graft function was seen in 60% of the patients and 21% had failed function. Graft function did not correlate with a history of pre-transplant or post-transplant urinary tract infection (p >0.2). Of transplanted patients with urological causes of renal failure 57% had post-transplant urinary tract infection, compared to only 20% of those with a medical etiology of renal failure (p <0.001). In this study there was no correlation between a history of urinary tract infection (either before or after transplant) and decreased graft function. History of pre-transplant urinary tract infection was suggestive of urinary tract infection after transplant. Patients with urological causes of renal failure may be at increased risk for post-transplant urinary tract infection.