Late urinary tract infection after renal transplantation in the United States

Abbott, Kevin C.; Swanson, S. John; Richter, Erich R.; Bohen, Erin M.; Agodoa, Lawrence Y.; Peters, Thomas G.; Barbour, Galen L.; Lipnick, Robert; Cruess, David F.

doi:10.1053/j.ajkd.2004.04.040

Cited by 289 publications

(243 citation statements)

References 22 publications

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“…15,16 Overall, infection rates with belatacept were typical for long-term renal transplant recipients, with the possible exception of herpes, which occurred at a higher rate than in previous reports in renal transplant recipients: 21 versus 7%. 17 UTI was the most common late serious infection, as was reported previously, 18 and CMV and BK polyomavirus infection rates with belatacept were similar to published results in CNItreated patients. 19,20 Our study was not powered to detect a difference in outcomes between the 4-and 8-week dosing groups; therefore, safety and efficacy were primarily analyzed using pooled data from both groups.…”

Section: Discussionsupporting

confidence: 75%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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Belatacept is a first-in-class co-stimulation blocker in development for primary maintenance immunosuppression. A Phase II study comparing belatacept with cyclosporine (CsA) for prevention of acute rejection and protection of renal function in kidney transplant recipients demonstrated similar efficacy and significantly higher measured GFR at 1 year for belatacept, but the incidence of posttransplantation lymphoproliferative disorder was higher. Here, we present the results for the extension of this trial, which aimed to assess long-term safety and efficacy of belatacept. Seventy-eight of 102 patients who were receiving belatacept and the 16 of 26 who were receiving CsA completed the long-term extension period. GFR remained stable in patients who were receiving belatacept for 5 years, and the incidences of death/graft loss or acute rejection were low. The frequencies of serious infections were 16% for belatacept and 27% for CsA, and neoplasms occurred in 12% of each group. No patients who were treated with belatacept and one patient who was treated with CsA developed posttransplantation lymphoproliferative disorder during the follow-up period. Serious gastrointestinal disorders occurred more frequently with belatacept (12% belatacept versus 8% CsA), and serious cardiac disorders occurred more frequently with CsA (2% belatacept versus 12% CsA). Pharmacokinetic analyses showed consistent exposure to belatacept over time. CD86 receptor saturation was higher in patients who were receiving belatacept every 4 weeks (74%) compared with every 8 weeks (56%). In conclusion, this study demonstrated high patient persistence with intravenous belatacept, stable renal function, predictable pharmacokinetics, and good safety with belatacept over 5 years.

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Section: Discussionsupporting

confidence: 75%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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“…UTIs are thought to be directly attributable to exposure to pathogens during the early postoperative period and to immunosuppressive therapy (67). A recent major retrospective study has revealed that UTIs occurring after renal transplantation are often associated with an increased risk of septic shock and subsequent death (68). Therefore, it cannot be excluded that the frequent occurrence of ascending pyelonephritis caused by UPECs in renal transplanted patients may be favored, at least in part, by alterations in the activation of cellular signaling pathways due to prolonged immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

Renal Collecting Duct Epithelial Cells React to Pyelonephritis-Associated Escherichia coli by Activating Distinct TLR4-Dependent and -Independent Inflammatory Pathways

Chassin

Goujon

Darche³

et al. 2006

The Journal of Immunology

119

156

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TLR4 plays a central role in resistance to pyelonephritis caused by uropathogenic Escherichia coli (UPEC). It has been suggested that renal tubule epithelial cells expressing TLRs may play a key role in inflammatory disorders and in initiating host defenses. In this study we used an experimental mouse model of ascending urinary tract infection to show that UPEC isolates preferentially adhered to the apical surface of medullary collecting duct (MCD) intercalated cells. UPEC-infected C3H/HeJ (Lpsd) mice carrying an inactivating mutation of tlr4 failed to clear renal bacteria and exhibited a dramatic slump in proinflammatory mediators as compared with infected wild-type C3H/HeOuJ (Lpsn) mice. However, the level of expression of the leukocyte chemoattractants MIP-2 and TNF-α still remained greater in UPEC-infected than in naive C3H/HeJ (Lpsd) mice. Using primary cultures of microdissected Lpsn MCDs that expressed TLR4 and its accessory molecules MD2, MyD88, and CD14, we also show that UPECs stimulated both a TLR4-mediated, MyD88-dependent, TIR domain-containing adaptor-inducing IFN-β-independent pathway and a TLR4-independent pathway, leading to bipolarized secretion of MIP-2. Stimulation by UPECs of the TLR4-mediated pathway in Lpsn MCDs leads to the activation of NF-κB, and MAPK p38, ERK1/2, and JNK. In addition, UPECs stimulated TLR4-independent signaling by activating a TNF receptor-associated factor 2-apoptosis signal-regulatory kinase 1-JNK pathway. These findings demonstrate that epithelial collecting duct cells are actively involved in the initiation of an immune response via several distinct signaling pathways and suggest that intercalated cells play an active role in the recognition of UPECs colonizing the kidneys.

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“…15 This latter finding was a result of a retrospective cohort study of 28 942 Medicare primary renal transplant recipients in the United States Renal Data System database, which studied the effects of early (ie, within 6 mo) versus late (ie, beyond 6 mo after transplant) posttransplant UTIs on patient survival and graft loss. The group concluded that late UTIs did not herald a benign outcome.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Tawab¹,

Gheith²,

Otaibi³

et al. 2017

Exp Clin Transplant

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Objectives: Urinary tract infection is the most common type of bacterial infection in kidney transplant procedures, with adverse effects on graft and patient survival. We aimed to evaluate the risk factors of recurrent urinary tract infection in renal transplant recipients and its impact on patient and graft survival. Materials and Methods: In a cohort of 1019 patients who were transplanted between 2000 and 2010 at Hamed Al-Essa Organ Transplant Center in Kuwait, 86% developed at least 1 episode of urinary tract infection, with only 6.2% of patients having recurrent infections. We compared patients with recurrent urinary tract infections (group 1) with those who had no recurrence (group 2) regarding their risk factors. Results: Patients in group 1 were significantly younger than those in group 2 (34.9 ± 23 vs 42.8 ± 16 y; P < .001), with female preponderance (P < .001). The percentage of patients with thymoglobulin induction (21.5%) was significantly higher in group 1. Patients with pretransplant urologic problems experienced significantly more recurrent urinary tract infections (P < .001). Hepatitis C infections were significantly more prevalent among group 1 (10.8% vs 3.8%; P = .008). Long-term graft outcome (functioning and failed) were 78.5% and 21.5% in group 1 versus 85.1% and 13.9% in group 2 (P = .18). Patient outcomes (living and deceased donors) were 98.4% and 1.6% in group 1 versus 95.7% and 4.3% in group 2 (P = .187). Conclusions: Adult females, thymoglobulin induction, pretransplant urologic problems, and hepatitis C infection were the risk factors of recurrent urinary tract infection among our renal transplant patients. However, recurrence did not adversely affect graft or patient survival.

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Late urinary tract infection after renal transplantation in the United States

Cited by 289 publications

References 22 publications

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Renal Collecting Duct Epithelial Cells React to Pyelonephritis-Associated Escherichia coli by Activating Distinct TLR4-Dependent and -Independent Inflammatory Pathways

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